Provider Demographics
NPI:1720234586
Name:HOLLIDAYSBURG PHARMACY LLC
Entity Type:Organization
Organization Name:HOLLIDAYSBURG PHARMACY LLC
Other - Org Name:THOMPSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-944-6139
Mailing Address - Street 1:510 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1808
Mailing Address - Country:US
Mailing Address - Phone:814-693-0270
Mailing Address - Fax:814-693-0271
Practice Address - Street 1:510 BLAIR ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1808
Practice Address - Country:US
Practice Address - Phone:814-693-0270
Practice Address - Fax:814-693-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116582OtherPK