Provider Demographics
NPI:1679667968
Name:CARRIGANS COUNTRY PHARMACY INC
Entity Type:Organization
Organization Name:CARRIGANS COUNTRY PHARMACY INC
Other - Org Name:CARRIGANS COUNTRY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-722-8861
Mailing Address - Street 1:PO BOX 1285
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-1285
Mailing Address - Country:US
Mailing Address - Phone:570-722-8861
Mailing Address - Fax:570-215-4393
Practice Address - Street 1:3 PINE POINT PLAZA
Practice Address - Street 2:
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210
Practice Address - Country:US
Practice Address - Phone:570-722-8861
Practice Address - Fax:570-722-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
PAPP414187L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00116226640001Medicaid
3958191OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1162264Medicaid
3958191OtherNCPDP PROVIDER IDENTIFICATION NUMBER