=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336611276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY RERICK PHARMD, BCACP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2018
-----------------------------------------------------
Last Update Date | 08/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 DAVES WAY
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19526-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-658-0313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 CHALFONT PL
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19606-9159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-574-6882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP451711
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------