Provider Demographics
NPI:1427109883
Name:ROGER J. FEURA BRADFORD PHARMACY
Entity type:Organization
Organization Name:ROGER J. FEURA BRADFORD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEURA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-362-6521
Mailing Address - Street 1:55 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2019
Mailing Address - Country:US
Mailing Address - Phone:814-362-6521
Mailing Address - Fax:814-362-3593
Practice Address - Street 1:55 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2019
Practice Address - Country:US
Practice Address - Phone:814-362-6521
Practice Address - Fax:814-362-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413546L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007289890002Medicaid
PA1007289890002Medicaid