Provider Demographics
NPI:1457870081
Name:SAEGERTOWN PHARMACY
Entity Type:Organization
Organization Name:SAEGERTOWN PHARMACY
Other - Org Name:SAEGERTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:814-573-7161
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-7617
Mailing Address - Country:US
Mailing Address - Phone:814-763-1103
Mailing Address - Fax:814-763-1107
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:SAEGERTOWN PLAZA
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433-7617
Practice Address - Country:US
Practice Address - Phone:814-763-1107
Practice Address - Fax:814-763-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171489OtherPK
PA1034867380001Medicaid