MEDICARE: SLATEBELT DRUGS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP411186L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3956452	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427164862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLATEBELT DRUGS INC

Provider Business Mailing Address
First Line	:	435 BLUE VALLEY DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-1513
Country	:	US
Telephone Number	:	610-863-6001
Fax Number	:	610-863-8343

Provider Business Practice Location Address
First Line	:	435 BLUE VALLEY DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-1513
Country	:	US
Telephone Number	:	610-863-6001
Fax Number	:	610-863-8343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VISWANADHAM GADEY
Credential	:
Telephone Number	:	908-454-4352

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/09/2012

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Directions to “SLATEBELT DRUGS INC ” Practice Location

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