Provider Demographics
NPI:1275668758
Name:HOFFMAN'S DRUG STORE,INC.
Entity Type:Organization
Organization Name:HOFFMAN'S DRUG STORE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-375-4111
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:536 FRANKLIN AVE
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-0429
Mailing Address - Country:US
Mailing Address - Phone:724-375-4111
Mailing Address - Fax:724-375-9419
Practice Address - Street 1:536 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-3728
Practice Address - Country:US
Practice Address - Phone:724-375-4111
Practice Address - Fax:724-375-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411073L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007785880002Medicaid
PA3956250OtherNCPDP NUMBER
PA0541560001Medicare NSC