Provider Demographics
NPI:1275217473
Name:PENNSYLVANIA NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN LDN
Authorized Official - Phone:717-201-4833
Mailing Address - Street 1:1744 SAMMAR RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5045
Mailing Address - Country:US
Mailing Address - Phone:717-201-4833
Mailing Address - Fax:
Practice Address - Street 1:1744 SAMMAR RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5045
Practice Address - Country:US
Practice Address - Phone:717-201-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty