| Organization Name: | TRADITIONAL APOTHECARY LLC |
| NPI Number: | 1649443938 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VINCENT CANZANESE (PRESIDENT) |
| Mailing Address: | 424 N Springfield Rd Clifton Heights |
| State: | PA US |
| Postal Code: | 190181304 |
| Phone Number: | 4844614555 |
| Fax Number: | 4844614556 |
| NPI Enumeration Date: | 04/08/2008 |
| NPI Last Update Date: | 06/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |