Provider Demographics
NPI:1306832308
Name:LENOX PHARMACY
Entity Type:Organization
Organization Name:LENOX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-222-5005
Mailing Address - Street 1:5879 SR 92
Mailing Address - Street 2:SUITE 3 LENOX PLAZA
Mailing Address - City:KINGSLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18826-9751
Mailing Address - Country:US
Mailing Address - Phone:570-222-5005
Mailing Address - Fax:570-222-5006
Practice Address - Street 1:5879 SR 92
Practice Address - Street 2:SUITE 3 LENOX PLAZA
Practice Address - City:KINGSLEY
Practice Address - State:PA
Practice Address - Zip Code:18826-9751
Practice Address - Country:US
Practice Address - Phone:570-222-5005
Practice Address - Fax:570-222-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-25
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PAPP414982L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014984970001Medicaid
PA0951580001Medicare ID - Type Unspecified