Provider Demographics
NPI:1972663086
Name:EARL W RHOADS
Entity Type:Organization
Organization Name:EARL W RHOADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-838-6355
Mailing Address - Street 1:30 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-1627
Mailing Address - Country:US
Mailing Address - Phone:717-838-6355
Mailing Address - Fax:717-832-0728
Practice Address - Street 1:30 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-1627
Practice Address - Country:US
Practice Address - Phone:717-838-6355
Practice Address - Fax:717-832-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413992L333600000X
PA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3954915OtherNCPDP #
PA0011045290002Medicaid
PA0011045290002Medicaid
PA0011045290002Medicaid
PA0736810001Medicare NSC