Provider Demographics
NPI:1932103587
Name:GUTHRIESVILLE PHARMACY INC
Entity Type:Organization
Organization Name:GUTHRIESVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIRHAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-269-7368
Mailing Address - Street 1:1169 HORSESHOE PIKE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1367
Mailing Address - Country:US
Mailing Address - Phone:610-269-7368
Mailing Address - Fax:610-269-2198
Practice Address - Street 1:1169 HORSESHOE PIKE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1367
Practice Address - Country:US
Practice Address - Phone:610-269-7368
Practice Address - Fax:610-269-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412413L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010818450001OtherMEDICAID
0010818450001OtherMEDICAID