Provider Demographics
NPI:1376244855
Name:HARROLDS PHARMACY INC LTC
Entity Type:Organization
Organization Name:HARROLDS PHARMACY INC LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-822-5794
Mailing Address - Street 1:250 OLD RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-1621
Mailing Address - Country:US
Mailing Address - Phone:570-822-5794
Mailing Address - Fax:570-824-8730
Practice Address - Street 1:250 OLD RIVER ROAD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-1621
Practice Address - Country:US
Practice Address - Phone:570-822-5794
Practice Address - Fax:570-824-8730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARROLDS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-13
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0076975130003Medicaid