Provider Demographics
NPI:1013699735
Name:SALEM CROSSROADS APOTHECARY LLC
Entity Type:Organization
Organization Name:SALEM CROSSROADS APOTHECARY LLC
Other - Org Name:SALEM CROSSROADS APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-468-5565
Mailing Address - Street 1:195 SHEFFIELD DR STE B
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1744
Mailing Address - Country:US
Mailing Address - Phone:724-468-5565
Mailing Address - Fax:724-468-8336
Practice Address - Street 1:195 SHEFFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1744
Practice Address - Country:US
Practice Address - Phone:724-468-5565
Practice Address - Fax:724-468-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy