Provider Demographics
NPI:1750467239
Name:MCCRACKEN PHARMACY INC
Entity Type:Organization
Organization Name:MCCRACKEN PHARMACY INC
Other - Org Name:MCCRACKEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-627-5454
Mailing Address - Street 1:595 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1805
Mailing Address - Country:US
Mailing Address - Phone:724-627-5454
Mailing Address - Fax:724-627-5429
Practice Address - Street 1:595 E HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-627-5454
Practice Address - Fax:724-627-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP 411522L332B00000X
333600000X
PAPP411522L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3927576OtherOTHER ID NUMBER
PA0008722280001Medicaid
0387320001Medicare NSC