Provider Demographics
NPI:1487683355
Name:CROSSROADS PHARMACY & GIFT INC
Entity Type:Organization
Organization Name:CROSSROADS PHARMACY & GIFT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEMPINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-825-4566
Mailing Address - Street 1:135 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-3338
Mailing Address - Country:US
Mailing Address - Phone:570-825-4566
Mailing Address - Fax:570-824-9090
Practice Address - Street 1:135 OXFORD ST
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-3338
Practice Address - Country:US
Practice Address - Phone:570-825-4566
Practice Address - Fax:570-824-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005717340002Medicaid
PA4529040001Medicare ID - Type Unspecified