Provider Demographics
NPI:1467543777
Name:ORWIGSBURG APOTHECARY LLC
Entity Type:Organization
Organization Name:ORWIGSBURG APOTHECARY LLC
Other - Org Name:THOMAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:OESTERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD RPH
Authorized Official - Phone:570-366-0381
Mailing Address - Street 1:101 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-1807
Mailing Address - Country:US
Mailing Address - Phone:570-366-0381
Mailing Address - Fax:570-366-0203
Practice Address - Street 1:101 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-1807
Practice Address - Country:US
Practice Address - Phone:570-366-0381
Practice Address - Fax:570-366-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412562L183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP412562LOtherPHARMACY LICENSE
PA104110667-0001Medicaid