Provider Demographics
NPI:1508938309
Name:TERMED OF BERKS COUNTY INC
Entity Type:Organization
Organization Name:TERMED OF BERKS COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-369-3888
Mailing Address - Street 1:2 E PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1125
Practice Address - Country:US
Practice Address - Phone:610-369-3888
Practice Address - Fax:610-369-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414973L333600000X, 3336L0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007680530002Medicaid
3969207OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PABT4290576OtherDEA #
3969207OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PAP00638185Medicare PIN
PA1007680530002Medicaid