1477107043 NPI number — GDD PHARMACY SERVICES INC

Table of content: (NPI 1477107043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477107043 NPI number — GDD PHARMACY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GDD PHARMACY SERVICES 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:
HARRISBURG LTC 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:
1477107043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 BENT CREEK BLVD STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-1874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-732-2112
Provider Business Mailing Address Fax Number:
717-732-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2645 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-232-0400
Provider Business Practice Location Address Fax Number:
717-232-7590
Provider Enumeration Date:
07/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SILBAUGH
Authorized Official First Name:
DARRIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
717-732-2112

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017986620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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