Provider Demographics
NPI:1003800657
Name:MILLERSBURG PHARMACY INC
Entity Type:Organization
Organization Name:MILLERSBURG PHARMACY INC
Other - Org Name:DOING BUSINESS AS DAL-HERN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-758-2042
Mailing Address - Street 1:4372 STATE ROUTE 147
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:PA
Mailing Address - Zip Code:17830-7439
Mailing Address - Country:US
Mailing Address - Phone:570-758-2042
Mailing Address - Fax:570-758-5486
Practice Address - Street 1:4372 STATE ROUTE 147
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7439
Practice Address - Country:US
Practice Address - Phone:570-758-2042
Practice Address - Fax:570-758-5486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DBA DAL-HERN PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414150L183500000X, 333600000X
PAPP412471L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007783180004Medicaid
PA3957391OtherNABP
0218900002Medicare NSC