Provider Demographics
NPI:1508852120
Name:CHOICE CRITICAL CARE RX LLC
Entity Type:Organization
Organization Name:CHOICE CRITICAL CARE RX LLC
Other - Org Name:CHOICE CRITICAL CARE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-630-2773
Mailing Address - Street 1:330 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-7831
Mailing Address - Country:US
Mailing Address - Phone:717-630-2773
Mailing Address - Fax:717-630-2824
Practice Address - Street 1:330 NORTH AVE
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-7831
Practice Address - Country:US
Practice Address - Phone:717-630-2773
Practice Address - Fax:717-630-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
PAPP414600L333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037377490001Medicaid
PA7812580001OtherNSC