Provider Demographics
NPI:1184620221
Name:LEWISTOWN PHARMACY, INC.
Entity type:Organization
Organization Name:LEWISTOWN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVATORE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:717-248-0041
Mailing Address - Street 1:7 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1771
Mailing Address - Country:US
Mailing Address - Phone:717-248-0041
Mailing Address - Fax:717-248-1128
Practice Address - Street 1:7 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1771
Practice Address - Country:US
Practice Address - Phone:717-248-0041
Practice Address - Fax:717-248-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411045L333600000X
332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005829160001Medicaid
3919149OtherPHARMACY NABP NUMBER
PA0005829160001Medicaid