Provider Demographics
NPI:1336276591
Name:HANOVER APOTHECARY INC.
Entity Type:Organization
Organization Name:HANOVER APOTHECARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-231-8248
Mailing Address - Street 1:310 STOCK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2276
Mailing Address - Country:US
Mailing Address - Phone:717-630-8835
Mailing Address - Fax:717-630-8836
Practice Address - Street 1:310 STOCK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-630-8835
Practice Address - Fax:717-630-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415041L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018275330001Medicaid