Healthcare Provider Details

I. General information

NPI: 1649275835
Provider Name (Legal Business Name): REDNER'S MARKETS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GOLD STAR PLZ
SHENANDOAH PA
17976-2530
US

IV. Provider business mailing address

3 GOLD STAR PLZ
SHENANDOAH PA
17976-2530
US

V. Phone/Fax

Practice location:
  • Phone: 570-462-9651
  • Fax: 570-462-3272
Mailing address:
  • Phone: 570-462-9651
  • Fax: 570-462-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP481111L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP481111
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3980035
Identifier TypeOTHER
Identifier State
Identifier IssuerNABP NUMBER
# 2
Identifier1007522960009
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. DONALD J VEGLIA
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 570-462-9651