Provider Demographics
NPI:1508110024
Name:SCOTT WERTZ
Entity Type:Organization
Organization Name:SCOTT WERTZ
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-378-1396
Mailing Address - Street 1:1170 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602-1349
Mailing Address - Country:US
Mailing Address - Phone:610-378-1396
Mailing Address - Fax:610-378-5529
Practice Address - Street 1:1170 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1349
Practice Address - Country:US
Practice Address - Phone:610-378-1396
Practice Address - Fax:610-378-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410055L3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137685OtherPK