Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 3336C0003X | Pharmacy | Community/Retail Pharmacy | PP411358L | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 0011951670002 24 | MEDICAID | PENNSYLVANIA | |
2 | 3959802 | OTHER | PENNSYLVANIA | ARGUS |
3 | 239598011373 | OTHER | PENNSYLVANIA | PACE SPECIAL BENEFITS |
4 | 3959802 | OTHER | PENNSYLVANIA | MEDICAL MATRIX |
5 | 3959802 | OTHER | PENNSYLVANIA | HUMANA |
6 | 3959802 | OTHER | PENNSYLVANIA | NATIONAL HEALTH ACCESS |
7 | 3959802 | OTHER | PENNSYLVANIA | GPP |
8 | 3959802 | OTHER | PENNSYLVANIA | MEMBER HEALTH |
9 | 039598011373 | OTHER | PENNSYLVANIA | PACE |
10 | 3959802 | OTHER | PENNSYLVANIA | MED IMPACT |
11 | 0742700001 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
12 | 3959802 | OTHER | PENNSYLVANIA | MILLENIUM HEALTH CARE |
13 | 139598011373 | OTHER | PENNSYLVANIA | PACE RENAL |
14 | 3959802 | OTHER | PENNSYLVANIA | AETNA |
15 | 3959802 | OTHER | PENNSYLVANIA | DIVERSIFIED |
16 | 3959802 | OTHER | PENNSYLVANIA | ADVANCE RX |
17 | 3959802 | OTHER | PENNSYLVANIA | MEDE AMERICA |
18 | 3959802 | OTHER | PENNSYLVANIA | BLUE CROSS OF CA |
19 | 3959802 | OTHER | PENNSYLVANIA | CIGNA RX PRIME |
20 | 3959802 | OTHER | PENNSYLVANIA | EXPRESS SCRIPTS |