Provider Demographics
NPI:1497810782
Name:PAOLI APOTHECARY LLC
Entity Type:Organization
Organization Name:PAOLI APOTHECARY LLC
Other - Org Name:STRARR PHARMACY SERVICES INC D/B/A PAOLI APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-251-2295
Mailing Address - Street 1:255 W. LANCASTER AVE
Mailing Address - Street 2:MOB 1 STE. 107
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-251-2295
Mailing Address - Fax:610-251-2294
Practice Address - Street 1:255 W. LANCASTER AVE
Practice Address - Street 2:MOB 1 STE. 107
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-251-2295
Practice Address - Fax:610-251-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4814243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124695OtherPK
PA1024684120001Medicaid