Provider Demographics
NPI:1558350116
Name:WOGAN ENTERPRISES INC
Entity Type:Organization
Organization Name:WOGAN ENTERPRISES INC
Other - Org Name:WOGANS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-359-5280
Mailing Address - Street 1:410 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-1224
Mailing Address - Country:US
Mailing Address - Phone:717-359-5280
Mailing Address - Fax:717-359-7428
Practice Address - Street 1:410 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1224
Practice Address - Country:US
Practice Address - Phone:717-359-5280
Practice Address - Fax:717-359-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP411812L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3948126OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA19107818901Medicaid