Provider Demographics
NPI:1457463721
Name:SLOAN'S PHARMACY, INC.
Entity Type:Organization
Organization Name:SLOAN'S PHARMACY, INC.
Other - Org Name:DBA SLOAN'S MANHEIM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-653-6888
Mailing Address - Street 1:73 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-1645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-1645
Practice Address - Country:US
Practice Address - Phone:717-665-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412162L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007569740001Medicaid
PW3947819OtherNCPDP #
PAPP412162LOtherSTATE LICENSE
PA1007569740001Medicaid