Provider Demographics
NPI:1700452158
Name:KLINGENSMITH DRUG INC
Entity Type:Organization
Organization Name:KLINGENSMITH DRUG INC
Other - Org Name:KLINGENSMITH'S DRUG STORES #7
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD TECH/3RD PARTY BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-763-4028
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-0151
Mailing Address - Country:US
Mailing Address - Phone:724-763-4028
Mailing Address - Fax:724-763-4040
Practice Address - Street 1:4075 THIRD STREET
Practice Address - Street 2:
Practice Address - City:NUMINE
Practice Address - State:PA
Practice Address - Zip Code:16244-0172
Practice Address - Country:US
Practice Address - Phone:724-783-7341
Practice Address - Fax:724-783-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742930026Medicaid
PA0946270006OtherMEDICAR
PAPP-411244LOtherSTATE BOARD OF PHARMACY
BK6688014OtherDEA