Healthcare Provider Details

I. General information

NPI: 1619018082
Provider Name (Legal Business Name): NAZARETH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S BROAD ST
NAZARETH PA
18064-2116
US

IV. Provider business mailing address

19 S BROAD ST
NAZARETH PA
18064-2116
US

V. Phone/Fax

Practice location:
  • Phone: 610-759-3240
  • Fax: 610-746-0946
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP411674L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS KAVANAGH
Title or Position: PRES
Credential:
Phone: 610-759-3240