MEDICARE: REDNER'S MARKETS, 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	PP481111L	PA
2	333600000X	Pharmacy	PP481111	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3980035	OTHER		NABP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649275835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDNER'S MARKETS, INC.

Provider Business Mailing Address
First Line	:	3 GOLD STAR PLZ
Second Line	:
City	:	SHENANDOAH
State	:	PA
Zip	:	17976-2530
Country	:	US
Telephone Number	:	570-462-9651
Fax Number	:	570-462-3272

Provider Business Practice Location Address
First Line	:	3 GOLD STAR PLZ
Second Line	:
City	:	SHENANDOAH
State	:	PA
Zip	:	17976-2530
Country	:	US
Telephone Number	:	570-462-9651
Fax Number	:	570-462-3272

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. DONALD J VEGLIA
Credential	:	RPH
Telephone Number	:	570-462-9651

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/07/2023

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Directions to “REDNER'S MARKETS, INC. ” Practice Location

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