Provider Demographics
NPI:1801971718
Name:BENSCREEK DRUG STORE
Entity type:Organization
Organization Name:BENSCREEK DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-288-1800
Mailing Address - Street 1:133 TIRE HILL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-7205
Mailing Address - Country:US
Mailing Address - Phone:814-288-1800
Mailing Address - Fax:
Practice Address - Street 1:133 TIRE HILL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-7205
Practice Address - Country:US
Practice Address - Phone:814-288-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410160L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0212760001Medicare ID - Type UnspecifiedMEDICARE