Provider Demographics
NPI:1205199445
Name:PA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Entity Type:Organization
Organization Name:PA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Other - Org Name:HOLLIDAYSBURG VETERANS HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-242-7789
Mailing Address - Street 1:138 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8460
Mailing Address - Country:US
Mailing Address - Phone:814-696-5201
Mailing Address - Fax:
Practice Address - Street 1:138 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8460
Practice Address - Country:US
Practice Address - Phone:814-696-5276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP417015L333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA247243Medicare PIN