MEDICARE: LIGONIER PHARMACY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PP413303L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3951755	OTHER	NCPDP
3	2085426	OTHER	PK

General Provider Information

NPI Number	:	1417945874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGONIER PHARMACY, INC.

Provider Business Mailing Address
First Line	:	113 S FAIRFIELD ST
Second Line	:	STE 1
City	:	LIGONIER
State	:	PA
Zip	:	15658-1163
Country	:	US
Telephone Number	:	724-238-6988
Fax Number	:	724-238-7781

Provider Business Practice Location Address
First Line	:	113 S FAIRFIELD ST
Second Line	:	STE 1
City	:	LIGONIER
State	:	PA
Zip	:	15658-1163
Country	:	US
Telephone Number	:	724-238-6988
Fax Number	:	724-238-7781

Authorized Official
Title or Position	:	PIC
Name	:	DIANA LYNN NEIDERHISER
Credential	:	R.PH.
Telephone Number	:	724-238-6988

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	01/14/2019

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Directions to “LIGONIER PHARMACY, INC. ” Practice Location

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