Provider Demographics
NPI:1457362022
Name:SHIPMANS PHARMACY INC
Entity Type:Organization
Organization Name:SHIPMANS PHARMACY INC
Other - Org Name:SHIPMANS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-826-5555
Mailing Address - Street 1:326 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1814
Mailing Address - Country:US
Mailing Address - Phone:610-826-5555
Mailing Address - Fax:610-826-5556
Practice Address - Street 1:326 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1814
Practice Address - Country:US
Practice Address - Phone:610-826-5555
Practice Address - Fax:610-826-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412541L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005851120001Medicaid
2079490OtherPK