Healthcare Provider Details

I. General information

NPI: 1922023886
Provider Name (Legal Business Name): CLARION DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 BROAD ST
NEW BETHLEHEM PA
16242
US

IV. Provider business mailing address

332 BROAD ST
NEW BETHLEHEM PA
16242
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-2211
  • Fax: 814-275-1977
Mailing address:
  • Phone: 814-275-2211
  • Fax: 814-275-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412054L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007277670001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. JOHN SLAGLE
Title or Position: BUSINESS AGENT
Credential: R.PH.
Phone: 814-226-5353