Provider Demographics
NPI:1861585044
Name:PHARMACON HOLDING CO INC
Entity type:Organization
Organization Name:PHARMACON HOLDING CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-366-7175
Mailing Address - Street 1:28 INTERMEDIATE UNIT DR
Mailing Address - Street 2:
Mailing Address - City:COAL CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15423-1045
Mailing Address - Country:US
Mailing Address - Phone:724-366-7175
Mailing Address - Fax:724-938-7838
Practice Address - Street 1:609 NATIONAL PIKE E
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9603
Practice Address - Country:US
Practice Address - Phone:724-366-7175
Practice Address - Fax:724-938-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413842L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085418OtherPK
PA0010606760002Medicaid
0757850001Medicare NSC