Provider Demographics
NPI:1407842974
Name:EAST BERLIN RX LLC
Entity Type:Organization
Organization Name:EAST BERLIN RX LLC
Other - Org Name:EAST BERLIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VENUGOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NARRAMNENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-259-0421
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:335 WEST KING STREET
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-1005
Mailing Address - Country:US
Mailing Address - Phone:717-259-0421
Mailing Address - Fax:717-259-7016
Practice Address - Street 1:335 W KING ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9730
Practice Address - Country:US
Practice Address - Phone:717-259-0421
Practice Address - Fax:717-259-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019797310002Medicaid
PA1019797310002Medicaid