MEDICARE: MEDICINE SHOPPE

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
1	333600000X	Pharmacy	PP415682L	PA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3977696	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1306958319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE SHOPPE

Provider Business Mailing Address
First Line	:	68 FRALEY ST
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-1325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 FRALEY ST
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-1325
Country	:	US
Telephone Number	:	814-837-2950
Fax Number	:	814-837-2954

Authorized Official
Title or Position	:	BILLING SPEC
Name	:	SUSAN GUINN
Credential	:
Telephone Number	:	314-993-6000

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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Directions to “MEDICINE SHOPPE ” Practice Location

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