MEDICARE: CHOICE CRITICAL CARE RX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	333600000X	Pharmacy	PP414600L	PA
4	3336L0003X	Long Term Care Pharmacy	PP414600L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7812580001	OTHER	PA	NSC

General Provider Information

NPI Number	:	1508852120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE CRITICAL CARE RX LLC

Provider Business Mailing Address
First Line	:	330 NORTH AVE
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-7831
Country	:	US
Telephone Number	:	717-630-2773
Fax Number	:	717-630-2824

Provider Business Practice Location Address
First Line	:	330 NORTH AVE
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-7831
Country	:	US
Telephone Number	:	717-630-2773
Fax Number	:	717-630-2824

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	PAUL MINNICH
Credential	:
Telephone Number	:	717-630-2773

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/07/2024

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