Healthcare Provider Details

I. General information

NPI: 1629111380
Provider Name (Legal Business Name): RXD OF SHENANDOAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 N MAIN ST
SHENANDOAH PA
17976-1777
US

IV. Provider business mailing address

PO BOX 428
COLLINGSWOOD NJ
08108-0428
US

V. Phone/Fax

Practice location:
  • Phone: 570-462-2763
  • Fax: 570-462-2097
Mailing address:
  • Phone: 856-858-9292
  • Fax: 856-858-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413262L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3945093
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCPDP
# 2
IdentifierPP413262L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE
# 3
Identifier0008878390001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. CRAIG E LEHRMAN
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 215-927-6700