Provider Demographics
NPI:1740399856
Name:REDNER'S MARKETS INC.
Entity Type:Organization
Organization Name:REDNER'S MARKETS INC.
Other - Org Name:REDNER'S PHARMACY #46
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF HUMAN RESOURCES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-248-5718
Mailing Address - Street 1:22 FOREST DR
Mailing Address - Street 2:UNIT #3
Mailing Address - City:HEGINS
Mailing Address - State:PA
Mailing Address - Zip Code:17938-9018
Mailing Address - Country:US
Mailing Address - Phone:570-682-3855
Mailing Address - Fax:570-682-3196
Practice Address - Street 1:22 FOREST DR
Practice Address - Street 2:UNIT #3
Practice Address - City:HEGINS
Practice Address - State:PA
Practice Address - Zip Code:17938-9013
Practice Address - Country:US
Practice Address - Phone:570-680-3855
Practice Address - Fax:570-682-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415076L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3970630OtherNCPDP
PAFR4985389OtherDEA
BM4633322OtherDEA
PA6700440001Medicare NSC