1497235196 NPI number — MINNICH'S PHARMACY INC

Table of content: (NPI 1497235196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497235196 NPI number — MINNICH'S PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINNICH'S PHARMACY 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:
1497235196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
974 S GEORGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-3708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-848-2312
Provider Business Mailing Address Fax Number:
717-854-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
974 S GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-3708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-848-2311
Provider Business Practice Location Address Fax Number:
877-563-1477
Provider Enumeration Date:
08/21/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-848-2311

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: 554816101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006995 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0012134610004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".