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General NPI Number Information
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NPI Number | 1619369840
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Entity Type | Organization
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Legal Business Name | NELLS FAMILY MARKET OF WALNUT BOTTOM LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 950 WALNUT BOTTOM RD
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City | CARLISLE
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State | PA
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Zip | 17015-7636
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Country | US
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Telephone | 717-243-3468
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Fax | 717-243-4610
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Provider Business Mailing Address
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Address Line | 950 WALNUT BOTTOM RD
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City | CARLISLE
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State | PA
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Zip | 17015-7636
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Country | US
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Telephone | 717-243-3468
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Fax | 717-243-4610
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | PAUL GRANGER
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Credential |
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Telephone | 717-324-4924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481485L
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License Number State | PA
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