Healthcare Provider Details

I. General information

NPI: 1104291707
Provider Name (Legal Business Name): MANCHESTER PHARMACY & MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 N GEORGE STREET EXT
MANCHESTER PA
17345-1307
US

IV. Provider business mailing address

4310 N GEORGE STREET EXT
MANCHESTER PA
17345-1307
US

V. Phone/Fax

Practice location:
  • Phone: 717-978-5142
  • Fax: 717-978-5126
Mailing address:
  • Phone: 717-978-5142
  • Fax: 717-978-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP482601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PRAMOD ARIKERI
Title or Position: PHARMACIST MANAGER
Credential:
Phone: 717-978-5142