Provider Demographics
NPI:1013940600
Name:GAUGHNS DRUG STORE
Entity Type:Organization
Organization Name:GAUGHNS DRUG STORE
Other - Org Name:GAUGHN'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:814-723-2840
Mailing Address - Street 1:348 PENNSYLVANIA AVE W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2424
Mailing Address - Country:US
Mailing Address - Phone:814-723-2840
Mailing Address - Fax:814-723-3830
Practice Address - Street 1:348 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2424
Practice Address - Country:US
Practice Address - Phone:814-723-2840
Practice Address - Fax:814-723-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410847L332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011434770001Medicaid
PA3927336OtherNABP NUMBER
PABG9066918OtherPHARMACY DEA NUMBER
PA1011434770001Medicaid