Healthcare Provider Details

I. General information

NPI: 1457870081
Provider Name (Legal Business Name): SAEGERTOWN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST SAEGERTOWN PLAZA
SAEGERTOWN PA
16433-7617
US

IV. Provider business mailing address

201 MAIN ST
SAEGERTOWN PA
16433-7617
US

V. Phone/Fax

Practice location:
  • Phone: 814-763-1107
  • Fax: 814-763-1103
Mailing address:
  • Phone: 814-763-1103
  • Fax: 814-763-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482778
License Number StatePA

VIII. Authorized Official

Name: ROBERT SWEENEY
Title or Position: PHARMACIST
Credential: PHARMACY
Phone: 814-573-7161