Provider Demographics
NPI:1073519906
Name:SHEELEY'S DRUG STORE INC
Entity Type:Organization
Organization Name:SHEELEY'S DRUG STORE INC
Other - Org Name:SHEELEY'S DRUG STORE,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH, PRES
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-8936
Mailing Address - Street 1:539 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1605
Mailing Address - Country:US
Mailing Address - Phone:570-342-8936
Mailing Address - Fax:570-343-1455
Practice Address - Street 1:539 LINDEN ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1605
Practice Address - Country:US
Practice Address - Phone:570-342-8936
Practice Address - Fax:570-343-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412267L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130496OtherPK