Provider Demographics
NPI:1831183474
Name:INTERDEPENDENT HOLDINGS INC
Entity type:Organization
Organization Name:INTERDEPENDENT HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-781-3192
Mailing Address - Street 1:229 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1235
Mailing Address - Country:US
Mailing Address - Phone:814-849-7300
Mailing Address - Fax:814-849-0074
Practice Address - Street 1:229 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1235
Practice Address - Country:US
Practice Address - Phone:814-849-7300
Practice Address - Fax:814-849-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
PAPP411513L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1242857Medicaid
3962708OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3962708OtherNCPDP PROVIDER IDENTIFICATION NUMBER