Provider Demographics
NPI:1588606156
Name:QUEEN PHARMACY INC
Entity Type:Organization
Organization Name:QUEEN PHARMACY INC
Other - Org Name:QUEEN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-394-0744
Mailing Address - Street 1:965 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3223
Mailing Address - Country:US
Mailing Address - Phone:717-394-0744
Mailing Address - Fax:717-392-5797
Practice Address - Street 1:965 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3223
Practice Address - Country:US
Practice Address - Phone:717-394-0744
Practice Address - Fax:717-392-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413172L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081314OtherPK
PA100760799Medicaid