Provider Demographics
NPI:1043302201
Name:SHURFINE WALNUT BOTTOM
Entity Type:Organization
Organization Name:SHURFINE WALNUT BOTTOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-243-3468
Mailing Address - Street 1:950 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7636
Practice Address - Country:US
Practice Address - Phone:717-243-3468
Practice Address - Fax:717-243-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4814853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3984754OtherOTHER ID NUMBER
PA1007781580014Medicaid
PA1007781580014Medicaid