Provider Demographics
NPI:1174683809
Name:NORRY PHARMACY
Entity Type:Organization
Organization Name:NORRY PHARMACY
Other - Org Name:NORRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:REG PH
Authorized Official - Phone:570-473-1126
Mailing Address - Street 1:125 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1910
Mailing Address - Country:US
Mailing Address - Phone:570-473-1126
Mailing Address - Fax:
Practice Address - Street 1:125 DUKE ST
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1910
Practice Address - Country:US
Practice Address - Phone:570-473-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP41370L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010144860001Medicaid
PA0793540001Medicare ID - Type Unspecified