MEDICARE: SHADY MAPLE PHARMACY

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	PP481512	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2087490	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932145950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADY MAPLE PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 137
Second Line	:
City	:	EAST EARL
State	:	PA
Zip	:	17519-0137
Country	:	US
Telephone Number	:	717-355-9424
Fax Number	:	717-351-0253

Provider Business Practice Location Address
First Line	:	1324 MAIN ST
Second Line	:
City	:	EAST EARL
State	:	PA
Zip	:	17519-9508
Country	:	US
Telephone Number	:	717-355-9424
Fax Number	:	717-351-0253

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MARK S EAST
Credential	:
Telephone Number	:	717-355-9424

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/11/2025

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Directions to “SHADY MAPLE PHARMACY ” Practice Location

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