Provider Demographics
NPI:1629111380
Name:RXD OF SHENANDOAH
Entity Type:Organization
Organization Name:RXD OF SHENANDOAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-927-6700
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-0428
Mailing Address - Country:US
Mailing Address - Phone:856-858-9292
Mailing Address - Fax:856-858-7286
Practice Address - Street 1:32 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1777
Practice Address - Country:US
Practice Address - Phone:570-462-2763
Practice Address - Fax:570-462-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413262L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3945093OtherNCPDP
PAPP413262LOtherSTATE LICENSE
PA0008878390001Medicaid
PAAR1935634OtherDEA
PA0008878390001Medicaid