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NPI Code Detail

MEDICARE: PERRY DRUG STORES INC AND SUBSIDIARIES

MEDICARE: PERRY DRUG STORES INC AND SUBSIDIARIES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy4184MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22337928OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1043226343
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERRY DRUG STORES INC AND SUBSIDIARIES
Provider Business Mailing Address
First Line : 200 NEWBERRY COMMONS
Second Line :
City : ETTERS
State : PA
Zip : 17319-9363
Country : US
Telephone Number : 717-761-2633
Fax Number : 717-975-8659
Provider Business Practice Location Address
First Line : 3669 WEST MAPLE
Second Line : BLOOMFIELD COMMONS
City : BLOOMFIELD HILLS
State : MI
Zip : 48301-3376
Country : US
Telephone Number : 248-647-4900
Fax Number :
Authorized Official
Title or Position : MANAGER ONLINE ADJUDICATION
Name : JENNIFER ZOREK
Credential :
Telephone Number : 717-975-5937
Provider Enumeration Date : 07/31/2006
Last Update Date : 12/12/2017

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