Provider Demographics
NPI:1417042839
Name:REDNER'S MARKETS, INC.
Entity Type:Organization
Organization Name:REDNER'S MARKETS, INC.
Other - Org Name:REDNER'S PHARMACY #20
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZEBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-926-3129
Mailing Address - Street 1:5471 POTTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8633
Mailing Address - Country:US
Mailing Address - Phone:610-926-3129
Mailing Address - Fax:610-916-6854
Practice Address - Street 1:5471 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8633
Practice Address - Country:US
Practice Address - Phone:610-926-3129
Practice Address - Fax:610-916-6854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDNER'S MARKETS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412257L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007522960006Medicaid
PA0997350001Medicare NSC