Provider Demographics
NPI:1114947025
Name:DONEGAL PHARMACY INC
Entity Type:Organization
Organization Name:DONEGAL PHARMACY INC
Other - Org Name:DONEGAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:724-593-2502
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:DONEGAL
Mailing Address - State:PA
Mailing Address - Zip Code:15628-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DONEGAL
Practice Address - State:PA
Practice Address - Zip Code:15628
Practice Address - Country:US
Practice Address - Phone:724-593-2502
Practice Address - Fax:724-593-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412746L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030370340001Medicaid
PA3942720OtherNABP
PAPP412746LOtherPA STATE LISENCE