1316946783 NPI number — QUARRYVILLE DRUG CO INC

Table of content: (NPI 1316946783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316946783 NPI number — QUARRYVILLE DRUG CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUARRYVILLE DRUG CO 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:
STRASBURG PHARMACY
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:
1316946783
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:
PO BOX 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRASBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17579-0326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-687-6058
Provider Business Mailing Address Fax Number:
717-687-6064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HISTORIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRASBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17579-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-687-6058
Provider Business Practice Location Address Fax Number:
717-687-6064
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAUB
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
717-687-6058

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP412421L , 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: 0390116 . This is a "ASSISTANCE FOR ELDERLY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007514120004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".