Provider Demographics
NPI:1235690835
Name:STAUFFERS DRUG STORE LTD
Entity Type:Organization
Organization Name:STAUFFERS DRUG STORE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:717-355-9300
Mailing Address - Street 1:149 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1282
Mailing Address - Country:US
Mailing Address - Phone:717-355-9300
Mailing Address - Fax:717-355-9302
Practice Address - Street 1:920 CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4656
Practice Address - Country:US
Practice Address - Phone:717-454-3530
Practice Address - Fax:717-450-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP482867OtherPHARMACY