Provider Demographics
NPI:1073528923
Name:KLINGENSMITH DRUG INC
Entity Type:Organization
Organization Name:KLINGENSMITH DRUG INC
Other - Org Name:KLINGENSMITHS DRUG STORES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:3RD PARTY BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-763-1201
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-0151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1215
Practice Address - Country:US
Practice Address - Phone:724-845-7501
Practice Address - Fax:724-845-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413324L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742930017Medicaid
3930270OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA561101Medicaid
3930270OtherOTHER ID NUMBER-COMMERCIAL NUMBER