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General NPI Number Information
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NPI Number | 1003999053
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Entity Type | Organization
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Legal Business Name | THE SHEPHERDS HEALTH MART PHARMACY
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 415 DELAWARE AVE
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City | PORTLAND
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State | PA
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Zip | 18351
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Country | US
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Telephone | 570-897-7437
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Fax | 570-897-2514
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Provider Business Mailing Address
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Address Line | 415 DELAWARE AVE
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City | PORTLAND
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State | PA
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Zip | 18351-0415
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Country | US
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Telephone | 570-897-7437
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Fax | 570-897-2501
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Authorized Official
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Title or Position | PROPRIETOR
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Name | ANGELA HART
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Credential |
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Telephone | 917-402-1685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481605
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License Number State | PA
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