Provider Demographics
NPI:1295819548
Name:CITIZENS PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:CITIZENS PHARMACY SERVICES INC
Other - Org Name:CITIZENS PHARMACY SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:POZANEK
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:410-939-4404
Mailing Address - Street 1:415A MARKET ST
Mailing Address - Street 2:STE B
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3301
Mailing Address - Country:US
Mailing Address - Phone:410-939-4404
Mailing Address - Fax:410-939-3609
Practice Address - Street 1:415A MARKET ST
Practice Address - Street 2:STE B
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3301
Practice Address - Country:US
Practice Address - Phone:410-939-4404
Practice Address - Fax:410-929-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDPW04733336L0003X
MDP000773104A0625X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD516620900Medicaid
MD453672000Medicaid
2038010OtherPK
2038010OtherPK