Provider Demographics
NPI:1316150741
Name:GREEN PARK HEALTH LLC DBA TROY PHARMACY
Entity type:Organization
Organization Name:GREEN PARK HEALTH LLC DBA TROY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH RP032893L
Authorized Official - Phone:412-915-3510
Mailing Address - Street 1:1612 LOWRIE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-732-0292
Mailing Address - Fax:412-904-2605
Practice Address - Street 1:1612 LOWRIE STREET
Practice Address - Street 2:TROY PHARMACY
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-904-2231
Practice Address - Fax:412-904-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820133336C0003X, 333600000X, 183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3954282OtherNCPDP PROVIDER IDENTIFICATION NUMBER