1730354291 NPI number — KLINGENSMITH'S DRUG STORES INC

Table of content: MS. CYNTHIA ANN PEDERSEN OTR/L, CHT (NPI 1700922721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730354291 NPI number — KLINGENSMITH'S DRUG STORES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLINGENSMITH'S DRUG STORES 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:
1730354291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 FORD ST FL 2
Provider Second Line Business Mailing Address:
P.O. BOX 151
Provider Business Mailing Address City Name:
FORD CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16226-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-763-2750
Provider Business Mailing Address Fax Number:
724-763-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 FORD ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORD CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16226-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-763-2750
Provider Business Practice Location Address Fax Number:
724-763-9257
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CIPPEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-763-2750

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014756160001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930023 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742930026 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014478270002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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