Healthcare Provider Details

I. General information

NPI: 1659544237
Provider Name (Legal Business Name): KLINGENSMITH DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 BROAD ST
NEW BETHLEHEM PA
16242-1004
US

IV. Provider business mailing address

PO BOX 151
FORD CITY PA
16226-0151
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-3424
  • Fax: 814-275-3428
Mailing address:
  • Phone: 724-763-1201
  • Fax: 724-763-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481809
License Number StatePA

VIII. Authorized Official

Name: JAMIE DAVIS
Title or Position: 3RD PARTY BILLING ADMIN
Credential:
Phone: 724-763-4028