PENN TRAFFIC CO (NPI# 1629099940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629099940 |
| Entity Type | Organization |
| Organization Name | PENN TRAFFIC CO |
| Other Organization Name | BILO FOODS AND PHARMACY 9003 |
| Practice Address |
100 N Main St Du Bois PA 15801-1888 |
| Mailing Address |
1200 State Fair Blvd Syracuse NY 13209-1070 |
| Practice Telephone | 8143719000 |
| Practice Fax Number | 8143759704 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2010-02-10 |
| Authorized Official Name | DANIEL J MAHONEY (SVP/GENERAL COUNSEL) |
| Authorized Official Telephone | 3154612347 |
| Authorized Official Credential | ESQ. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | PP412682L | PA | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA PROMISE- MEDICAID | 1007783900001 | 01 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 3961035 | 01 | |
| PA | 01215180 | 05 | |
| NCPDP | 3961035 | 01 |
| Other Name | Type Code |
|---|---|
| BILO FOODS AND PHARMACY 9003 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174544498 | Penn Traffic Co | Pharmacy | 40 S White St, Brookville, PA 15825-2422 | 2006-07-21 |
| 1083635304 | Penn Traffic Co | Pharmacy | 1305 E Main St, Clarion, PA 16214-1213 | 2006-07-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Vermont Business Registrations | PENN TRAFFIC COMPANY THE | Po Box 4737, Syracuse, NY 13221 |
| Street Address |
100 N MAIN ST |
| City | DU BOIS |
| State | PA |
| Zip Code | 15801-1888 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306166715 | Giant Eagle, Inc | Pharmacy | 100 N Main St, Du Bois, PA 15801-1888 | 2010-06-08 |
| 1609927904 | Lawrence Leon Labenne | Pharmacist | 100 N Main St, Du Bois, PA 15801-1888 | 2007-01-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215551452 | Grace Polohonki | Counselor | 490 Jefers Street, Dubois, PA 15801 | 2020-06-03 |
| 1144869231 | Richard Lee Kerstetter II | Hearing Instrument Specialist | 124 San Juan Rd, Du Bois, PA 15801 | 2020-01-06 |
| 1700368487 | Holly Noel Knoll | Counselor | 490 Jeffers Street, Dubois, PA 15801 | 2018-08-30 |
| 1992298160 | Dubois Regional Medical Center | Family Medicine | 145 Hospital Ave Ste 315, Du Bois, PA 15801 | 2018-06-12 |
| 1154814846 | Sara Beth Stone | Dietitian, Registered | 16288 Treasure Lk, Du Bois, PA 15801 | 2018-06-07 |
| 1942790779 | Wendi Dawn Wenzel | Counselor | 490 Jeffers St., Dubois, PA 15801 | 2018-05-17 |
| 1144748443 | Nancy Foradora | Massage Therapist | 200 Narrows Creek Park Road, Dubois, PA 15801 | 2017-09-07 |
| 1679098891 | Deborah Jean Mitchell | Hearing Instrument Specialist | 900 Beaver Drive, Dubois, PA 15801 | 2017-08-09 |
| 1861937757 | Shaun M Kanouff | Counselor | 100 Caldwell Dr., Dubois, PA 15801 | 2016-12-30 |
| 1164897740 | Drayer Physical Therapy Institute LLC | Physical Therapist | 873 Beaver Drive, Dubois, PA 15801 | 2015-12-08 |
| Find all providers in zip 15801 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336517648 | Dubois Regional Medical Center | Pharmacy | 621 S Main St, Du Bois, PA 15801-1413 | 2015-09-03 |
| 1306166715 | Giant Eagle, Inc | Pharmacy | 100 N Main St, Du Bois, PA 15801-1888 | 2010-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376143990 | Valerie Hellriegel | Pharmacy | 567 N Route 100, Bechtelsville, PA 19505-9263 | 2020-11-01 |
| 1134729791 | John P Russo | Pharmacy | 608 E Hillcrest Ave, New Castle, PA 16105-2254 | 2020-10-31 |
| 1538769864 | Luzerne Discount Pharmacy Inc | Pharmacy | 101 Main St Unit D, Luzerne, PA 18709-1209 | 2020-10-27 |
| 1417555616 | Dubois Regional Medical Center | Pharmacy | 265 Holiday Inn Drive Route 68, Clarion, PA 16214 | 2020-10-12 |
| 1780290197 | Weis Markets, Inc. | Pharmacy | 112 Atlantic Ave., Dingmans Ferry, PA 18328 | 2020-09-21 |
| 1275146177 | Newport Pharmacy LLC | Pharmacy | 57 S 2nd St, Newport, PA 17074-1402 | 2020-08-28 |
| 1699387779 | Allegheny Valley Hospital Retail Pharmacy | Pharmacy | 1301 Carlisle St Fl 3, Natrona Heights, PA 15065-1152 | 2020-08-19 |
| 1396355426 | Mdk Health | Pharmacy | 3985 Columbia Ave Unit 2, Columbia, PA 17512-9003 | 2020-08-04 |
| 1861000861 | Koso,llc | Pharmacy | 407 Shadeland Ave, Drexel Hill, PA 19026-1437 | 2020-07-16 |
| 1184241408 | Roosevelt Pharmacy LLC | Pharmacy | 2600 Cottman Ave, Philadelphia, PA 19149-1301 | 2020-07-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.