Healthcare Provider Details

I. General information

NPI: 1336259647
Provider Name (Legal Business Name): NELLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 PENN AVE
SINKING SPRING PA
19608-9672
US

IV. Provider business mailing address

4724 PENN AVE
SINKING SPRING PA
19608-9672
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-6610
  • Fax: 610-678-7710
Mailing address:
  • Phone: 610-678-6610
  • Fax: 610-678-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP415482L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierPP415482L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE
# 2
Identifier1007781580001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPROMISE ID
# 3
Identifier0397540
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPACE
# 4
Identifier01726823
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier3975402
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCPDP

VIII. Authorized Official

Name: DARRELL ROSENBERGER
Title or Position: PHARMACY MANAGER
Credential:
Phone: 610-678-6610