Provider Demographics
NPI:1639184237
Name:THE RX SHOPPE INC
Entity Type:Organization
Organization Name:THE RX SHOPPE INC
Other - Org Name:THE RX SHOPPE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSP
Authorized Official - Phone:717-919-8936
Mailing Address - Street 1:672 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYKENS
Mailing Address - State:PA
Mailing Address - Zip Code:17048-1309
Mailing Address - Country:US
Mailing Address - Phone:717-453-7662
Mailing Address - Fax:717-453-7999
Practice Address - Street 1:672 MAIN ST
Practice Address - Street 2:
Practice Address - City:LYKENS
Practice Address - State:PA
Practice Address - Zip Code:17048-1309
Practice Address - Country:US
Practice Address - Phone:717-453-7662
Practice Address - Fax:717-453-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4813263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086792OtherPK
PA1008927890001Medicaid
PA1008927890001Medicaid