Provider Demographics
NPI:1407861032
Name:HESS PHARMACY INC
Entity Type:Organization
Organization Name:HESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MYKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALATA
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:610-866-5511
Mailing Address - Street 1:745 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:745 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-4241
Practice Address - Country:US
Practice Address - Phone:610-866-5511
Practice Address - Fax:610-866-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411036L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3915191OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0014942640001Medicaid
3915191OtherOTHER ID NUMBER