Provider Demographics
NPI:1952413965
Name:MINNICH'S PHARMACY INC
Entity Type:Organization
Organization Name:MINNICH'S PHARMACY INC
Other - Org Name:MEDICINE SHOPPE YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-848-2312
Mailing Address - Street 1:1698 S.QUEEN ST.
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-846-0500
Mailing Address - Fax:717-845-8767
Practice Address - Street 1:1698 S.QUEEN ST.
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-846-0500
Practice Address - Fax:717-845-8767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNICH'S PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412564L332B00000X, 332BP3500X, 333600000X, 3336H0001X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008749690001Medicaid
3961794OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3961794OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3961794OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1008749690001Medicaid