1598819948 NPI number — FRANKLIN PA PHARMACY LLC

Table of content: JENNIFER ELIZABETH PAYNE M.D. (NPI 1154640100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598819948 NPI number — FRANKLIN PA PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANKLIN PA PHARMACY LLC
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:
1598819948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 CONNEAUT LAKE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16125-2167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-612-2131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E ATLANTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16323-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-437-9111
Provider Business Practice Location Address Fax Number:
814-437-1263
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALBERG
Authorized Official First Name:
BRETTON
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
724-612-2131

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP411894L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3939963 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005585270001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".