South Park Pharmacy LLC
NPI #1922135763 in Lackawanna, New York
Provider Information
- NPI Number
- 1922135763
- Entity Type
- Organization
- Organization Name
- South Park Pharmacy LLC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Feb 28, 2007
- Last Updated
- Apr 21, 2017
Practice Location
- Address
- 2707 S PARK AVE
- City
- Lackawanna
- State
- New York
- ZIP Code
- 14218-1511
- Phone
- (716) 823-0440
Authorized Official
- Name
- SHAWN SHELTON, RPH
- Title
- OWNER/PIC/AO
- Phone
- (716) 823-0440
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy |
| Durable Medical Equipment & Medical Supplies |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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