Provider Demographics
NPI:1205228442
Name:NELLS FAMILY MARKET OF EAST BERLIN LLC
Entity Type:Organization
Organization Name:NELLS FAMILY MARKET OF EAST BERLIN LLC
Other - Org Name:NELL'S PHARMACY EAST BERLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-324-4924
Mailing Address - Street 1:NELL'S ACCOUNTING
Mailing Address - Street 2:600 ARSENAL ROAD
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-854-1505
Mailing Address - Fax:914-407-1649
Practice Address - Street 1:30 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-8505
Practice Address - Country:US
Practice Address - Phone:717-259-6598
Practice Address - Fax:717-259-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415789L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150483OtherPK