Provider Demographics
NPI:1386650794
Name:TRUCKSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:TRUCKSVILLE PHARMACY LLC
Other - Org Name:TRUCKSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-696-2222
Mailing Address - Street 1:13 CARVERTON RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 CARVERTON RD
Practice Address - Street 2:
Practice Address - City:TRUCKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18708-1712
Practice Address - Country:US
Practice Address - Phone:570-696-2222
Practice Address - Fax:570-696-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
PAPP412733L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3913349OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0007854450001Medicaid
5474380001Medicare ID - Type Unspecified