Provider Demographics
NPI:1578642526
Name:STAUFFERS DRUG STORE LTD
Entity Type:Organization
Organization Name:STAUFFERS DRUG STORE LTD
Other - Org Name:STAUFFER'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:LOY
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:717-355-9300
Mailing Address - Street 1:149 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1227
Mailing Address - Country:US
Mailing Address - Phone:717-355-9300
Mailing Address - Fax:717-355-9302
Practice Address - Street 1:149 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1227
Practice Address - Country:US
Practice Address - Phone:717-355-9300
Practice Address - Fax:717-355-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412789L183500000X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3949320OtherNABP
PA0009997550002Medicaid
PA0561310001Medicare NSC
PA3949320OtherNABP