Provider Demographics
NPI:1407900855
Name:MADJAK INC
Entity Type:Organization
Organization Name:MADJAK INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BILSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-457-3372
Mailing Address - Street 1:730 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1459
Practice Address - Country:US
Practice Address - Phone:570-457-3372
Practice Address - Fax:570-457-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415319L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016612640002Medicaid
3973410OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3973410OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1189970001Medicare NSC