Provider Demographics
NPI:1801214309
Name:CELLERARI PHARMACY INC
Entity Type:Organization
Organization Name:CELLERARI PHARMACY INC
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CELLERARI
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CELLERARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-498-6410
Mailing Address - Street 1:100 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1750
Mailing Address - Country:US
Mailing Address - Phone:570-586-1961
Mailing Address - Fax:570-587-0319
Practice Address - Street 1:100 E GROVE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1750
Practice Address - Country:US
Practice Address - Phone:570-586-1961
Practice Address - Fax:570-587-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
PAPP411526L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029631550001Medicaid
2147024OtherPK