Provider Demographics
NPI:1922023886
Name:CLARION DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:CLARION DEVELOPMENT CORPORATION
Other - Org Name:NEW BETHLEHEM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-226-5353
Mailing Address - Street 1:332 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242
Mailing Address - Country:US
Mailing Address - Phone:814-275-2211
Mailing Address - Fax:814-275-1977
Practice Address - Street 1:332 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242
Practice Address - Country:US
Practice Address - Phone:814-275-2211
Practice Address - Fax:814-275-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412054L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277670001Medicaid
PA0671550001Medicare NSC