Provider Demographics
NPI:1649275835
Name:REDNER'S MARKETS, INC.
Entity type:Organization
Organization Name:REDNER'S MARKETS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VEGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-462-9651
Mailing Address - Street 1:3 GOLD STAR PLZ
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-2530
Mailing Address - Country:US
Mailing Address - Phone:570-462-9651
Mailing Address - Fax:570-462-3272
Practice Address - Street 1:3 GOLD STAR PLZ
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-2530
Practice Address - Country:US
Practice Address - Phone:570-462-9651
Practice Address - Fax:570-462-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481111L332B00000X
PAPP481111333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3980035OtherNABP NUMBER
PA1007522960009Medicaid
PA1007522960009Medicaid
PA1007522960009Medicaid