CC Blue Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP414165L Issued in PA

Legal business name

CC BLUE INC

Practice address

1234 W Main St
Monongahela, PA 15063-2830

Phone

(724) 258-5055

Fax

(724) 258-7806

NPI assigned

Feb 21, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dena Ferman

Title

Third Party Plan Coordinator

Phone

(314) 993-6000

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICINE SHOPPE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1740325372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 W MAIN ST",
            "city": "MONONGAHELA",
            "state": "PA",
            "postal_code": "150632830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 W MAIN ST",
            "city": "MONONGAHELA",
            "state": "PA",
            "postal_code": "150632830",
            "telephone_number": "724-258-5055",
            "fax_number": "724-258-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CC BLUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "FERMAN",
        "authorized_official_first_name": "DENA",
        "authorized_official_title_or_position": "THIRD PARTY PLAN COORDINATOR",
        "authorized_official_telephone_number": "314-993-6000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP414165L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3957719",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017521170001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guido Candelore, P.T.
• Heather Cappello
• Marshall S Carlin, D.O.
• Diana Carrola, DO
• Devon Marie Carson, CRNP
• Paul N Cervone, M.D.
• Vinod N Chablani, M.D.
• Stacy Ann Chandler, RDH
• Abdul S Chaudry, M.D.
• Children'S Community Care

• Community/Retail Pharmacy in Monongahela, PA
• Providers in Monongahela, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.