1962502278 NPI number — CLEMENS MARKET INC

Table of content: (NPI 1962502278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962502278 NPI number — CLEMENS MARKET INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEMENS MARKET INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEMENS PHARMACY AT HARLEYSVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962502278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RTE 63 AND 113
Provider Second Line Business Mailing Address:
THE SHOPS OF HARLEYSVILLE
Provider Business Mailing Address City Name:
HARLEYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RTE 63 AND 113
Provider Second Line Business Practice Location Address:
THE SHOPS OF HARLEYSVILLE
Provider Business Practice Location Address City Name:
HARLEYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-513-0400
Provider Business Practice Location Address Fax Number:
215-513-2965
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF PHARMACY
Authorized Official Telephone Number:
215-361-9000

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP481234 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3981570 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007768230010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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