Provider Demographics
NPI:1568039477
Name:KLINGENSMITH DRUG INC
Entity Type:Organization
Organization Name:KLINGENSMITH DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3RD PARTY BILLING ADMIN/LEAD TECH
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-763-4028
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-0151
Mailing Address - Country:US
Mailing Address - Phone:724-763-4028
Mailing Address - Fax:724-763-4040
Practice Address - Street 1:316 1ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2264
Practice Address - Country:US
Practice Address - Phone:724-548-5500
Practice Address - Fax:724-548-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742930010Medicaid