=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639184237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RX SHOPPE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 04/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 672 MAIN ST
-----------------------------------------------------
City | LYKENS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17048-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-453-7662
-----------------------------------------------------
Fax | 717-453-7999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 672 MAIN ST
-----------------------------------------------------
City | LYKENS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17048-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-453-7662
-----------------------------------------------------
Fax | 717-453-7999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | ROBERT KILLORAN
-----------------------------------------------------
Credential | B.S.P.
-----------------------------------------------------
Telephone | 717-919-8936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP481326
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------