Provider Demographics
NPI:1619049764
Name:BOERSTLERS PHARMACY
Entity Type:Organization
Organization Name:BOERSTLERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BOERSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-866-5037
Mailing Address - Street 1:39 E ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6505
Mailing Address - Country:US
Mailing Address - Phone:610-866-5037
Mailing Address - Fax:
Practice Address - Street 1:39 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-866-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410216L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5025440001Medicare ID - Type Unspecified