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General NPI Number Information
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NPI Number | 1982603189
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Entity Type | Organization
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Legal Business Name | MEDICAL SHOPPE LTD
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 1101 MAIN ST
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City | HONESDALE
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State | PA
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Zip | 18431-1907
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Country | US
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Telephone | 570-253-7770
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Fax | 570-251-7809
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Provider Business Mailing Address
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Address Line | 1101 MAIN ST.
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City | HONESDALE
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State | PA
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Zip | 18431
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Country | US
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Telephone | 570-253-7770
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Fax | 570-251-7809
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUDITH A STEPHENS
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Credential | RN
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Telephone | 570-253-7700
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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 | PP414702L
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License Number State | PA
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