Healthcare Provider Details

I. General information

NPI: 1891799326
Provider Name (Legal Business Name): BIRDSBORO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST STE 3
BIRDSBORO PA
19508-2254
US

IV. Provider business mailing address

PO BOX 398
BIRDSBORO PA
19508-0398
US

V. Phone/Fax

Practice location:
  • Phone: 610-582-4005
  • Fax: 610-404-4512
Mailing address:
  • Phone: 610-582-5136
  • Fax: 610-404-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP413942L
License Number StatePA

VIII. Authorized Official

Name: MARTIN JOHN KENDRA
Title or Position: PRESIDENT
Credential: RPH
Phone: 610-582-4004