Provider Demographics
NPI:1598724387
Name:SJ HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SJ HEALTH SERVICES, LLC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WITTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-6303
Mailing Address - Street 1:145 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3501
Mailing Address - Country:US
Mailing Address - Phone:610-208-4660
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3501
Practice Address - Country:US
Practice Address - Phone:610-208-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415364L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773975Medicaid
PA0551160003Medicare ID - Type Unspecified