Provider Demographics
NPI:1619240025
Name:CL CRESSLER INC
Entity Type:Organization
Organization Name:CL CRESSLER INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-766-6191
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-1219
Mailing Address - Country:US
Mailing Address - Phone:717-766-6191
Mailing Address - Fax:717-691-1052
Practice Address - Street 1:3913 HARTZDALE DR
Practice Address - Street 2:SUITE 1306
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7845
Practice Address - Country:US
Practice Address - Phone:717-766-6191
Practice Address - Fax:717-691-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
PAPP4815753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018224450018Medicaid
PA0018224450018Medicaid