Provider Demographics
NPI:1578541413
Name:CENTRAL PA PHARMACY LLC.
Entity Type:Organization
Organization Name:CENTRAL PA PHARMACY LLC.
Other - Org Name:PATTON PHARMACY AND V&S VARIETY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:814-674-3693
Mailing Address - Street 1:503 RAILROAD AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-1342
Mailing Address - Country:US
Mailing Address - Phone:814-674-3693
Mailing Address - Fax:814-674-5446
Practice Address - Street 1:503 RAILROAD AVE
Practice Address - Street 2:STE 2
Practice Address - City:PATTON
Practice Address - State:PA
Practice Address - Zip Code:16668-1342
Practice Address - Country:US
Practice Address - Phone:814-674-3693
Practice Address - Fax:814-674-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-31
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413554L183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009594190002Medicaid
0200140001Medicare NSC