Provider Demographics
NPI:1255329231
Name:MINNICH'S PHARMACY INC
Entity Type:Organization
Organization Name:MINNICH'S PHARMACY INC
Other - Org Name:MINNICH'S COLONIAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:717-848-2312
Mailing Address - Street 1:976 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3708
Mailing Address - Country:US
Mailing Address - Phone:717-848-2312
Mailing Address - Fax:717-854-9501
Practice Address - Street 1:976 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3708
Practice Address - Country:US
Practice Address - Phone:717-848-2312
Practice Address - Fax:717-854-9501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNICH'S PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-12
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411604L333600000X, 3336C0003X, 3336L0003X, 3336S0011X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012134610002Medicaid
3960968OtherNABP
PA0012134610002Medicaid