Provider Demographics
NPI:1245074939
Name:LEWISBURG PHARMACY HOMECARE
Entity type:Organization
Organization Name:LEWISBURG PHARMACY HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-768-4446
Mailing Address - Street 1:50 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1567
Mailing Address - Country:US
Mailing Address - Phone:570-768-4446
Mailing Address - Fax:570-768-4448
Practice Address - Street 1:50 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1567
Practice Address - Country:US
Practice Address - Phone:570-768-4446
Practice Address - Fax:570-768-4448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWISBURG PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-19
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy