Provider Demographics
NPI:1659650018
Name:ALBERTS PHARMACY INC
Entity Type:Organization
Organization Name:ALBERTS PHARMACY INC
Other - Org Name:ALBERTS PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-299-5150
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1621
Mailing Address - Country:US
Mailing Address - Phone:570-299-5150
Mailing Address - Fax:570-299-5155
Practice Address - Street 1:201 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1621
Practice Address - Country:US
Practice Address - Phone:570-299-5150
Practice Address - Fax:570-299-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PAPP4821693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026125700001Medicaid
2131412OtherPK
6693150001Medicare NSC