Provider Demographics
NPI:1932269172
Name:MIKES PHARMACY INC
Entity Type:Organization
Organization Name:MIKES PHARMACY INC
Other - Org Name:MIKES PHARMACY, MEDICINE SHOPPE 2055
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERBE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-866-7547
Mailing Address - Street 1:211 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1036
Mailing Address - Country:US
Mailing Address - Phone:717-866-7547
Mailing Address - Fax:717-866-9063
Practice Address - Street 1:211 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1036
Practice Address - Country:US
Practice Address - Phone:717-866-7547
Practice Address - Fax:717-866-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410879L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015283350001Medicaid
2082447OtherPK