Healthcare Provider Details

I. General information

NPI: 1407842974
Provider Name (Legal Business Name): EAST BERLIN RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W KING ST
EAST BERLIN PA
17316-9730
US

IV. Provider business mailing address

PO BOX 1005 335 WEST KING STREET
EAST BERLIN PA
17316-1005
US

V. Phone/Fax

Practice location:
  • Phone: 717-259-0421
  • Fax: 717-259-7016
Mailing address:
  • Phone: 717-259-0421
  • Fax: 717-259-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VENUGOPAL NARRAMNENI
Title or Position: MEMBER
Credential:
Phone: 717-259-0421