| Organization Name: | EVANS CITY DRUG STORE INC |
| NPI Number: | 1114096807 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY MUSTOVIC (PRESIDENT) |
| Mailing Address: | 201 E Main St Evans City |
| State: | PA US |
| Postal Code: | 160331219 |
| Phone Number: | 7245384240 |
| Fax Number: | 7245383826 |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 05/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PP412566L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |