Provider Demographics
NPI:1356443642
Name:NAZARETH PHARMACY INC
Entity Type:Organization
Organization Name:NAZARETH PHARMACY INC
Other - Org Name:NAZARETH MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-759-3240
Mailing Address - Street 1:19 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2116
Mailing Address - Country:US
Mailing Address - Phone:610-759-3240
Mailing Address - Fax:610-746-0946
Practice Address - Street 1:19 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2116
Practice Address - Country:US
Practice Address - Phone:610-759-3240
Practice Address - Fax:610-746-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA48107286332B00000X, 332BX2000X, 335E00000X
PAPP411674L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005835840003Medicaid
PAPP411674LOtherPHARMACY LICENSE
PA0005835840002Medicaid
PAPP411674LOtherPHARMACY LICENSE
PA0005835840002Medicaid