Provider Demographics
NPI:1578883930
Name:BROADWAY PHARMACY
Entity Type:Organization
Organization Name:BROADWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:717-632-8070
Mailing Address - Street 1:848 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2029
Mailing Address - Country:US
Mailing Address - Phone:717-632-8070
Mailing Address - Fax:717-632-8076
Practice Address - Street 1:848 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2029
Practice Address - Country:US
Practice Address - Phone:717-632-8070
Practice Address - Fax:717-632-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410750L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy