1740399856 NPI number — REDNER'S MARKETS INC.

Table of content: (NPI 1740399856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740399856 NPI number — REDNER'S MARKETS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDNER'S MARKETS 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:
1740399856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 FOREST DR
Provider Second Line Business Mailing Address:
UNIT #3
Provider Business Mailing Address City Name:
HEGINS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17938-9018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-682-3855
Provider Business Mailing Address Fax Number:
570-682-3196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 FOREST DR
Provider Second Line Business Practice Location Address:
UNIT #3
Provider Business Practice Location Address City Name:
HEGINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17938-9013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-680-3855
Provider Business Practice Location Address Fax Number:
570-682-3196
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONOUGH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF HUMAN RESOURCES
Authorized Official Telephone Number:
484-248-5718

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP415076L , 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: 3970630 . This is a "NCPDP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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