Provider Demographics
NPI:1740398825
Name:CL CRESSLER INC
Entity Type:Organization
Organization Name:CL CRESSLER INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-766-6191
Mailing Address - Street 1:4999 LOUISE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6907
Mailing Address - Country:US
Mailing Address - Phone:717-766-6191
Mailing Address - Fax:717-691-1052
Practice Address - Street 1:3289 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145-3739
Practice Address - Country:US
Practice Address - Phone:724-376-3808
Practice Address - Fax:724-376-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412192L333600000X, 3336L0003X
PA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3930511OtherNCPDP #
PA0018224450001Medicaid
PA0018224450001Medicaid
PABT6946478OtherDEA #
PA3860220001Medicare NSC