Provider Demographics
NPI:1891799326
Name:BIRDSBORO PHARMACY INC
Entity Type:Organization
Organization Name:BIRDSBORO PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-582-4004
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-0398
Mailing Address - Country:US
Mailing Address - Phone:610-582-5136
Mailing Address - Fax:610-404-4512
Practice Address - Street 1:200 W 1ST ST STE 3
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2254
Practice Address - Country:US
Practice Address - Phone:610-582-4005
Practice Address - Fax:610-404-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413942L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001485659Medicaid
PA3953898OtherNCPDP
PA001485659Medicaid