1144320458 NPI number — CLEMENS MARKET INC

Table of content: MERRILL BURGETT BSN, RN, IBCLC (NPI 1285455444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144320458 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:
Provider Other Organization Name Type Code:
6
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:
1144320458
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 202 AND 73
Provider Second Line Business Mailing Address:
CENTER SQUARE PLAZA
Provider Business Mailing Address City Name:
CENTER SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19422
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 202 AND 73
Provider Second Line Business Practice Location Address:
CENTER SQUARE PLAZA
Provider Business Practice Location Address City Name:
CENTER SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-279-9869
Provider Business Practice Location Address Fax Number:
610-279-9612
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:  PP415767L , 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: 3978890 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007768230001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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