MEDICARE: TERRANOVA RX

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	PP414568L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2138243	OTHER		PK

General Provider Information

NPI Number	:	1942208269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRANOVA RX

Provider Business Mailing Address
First Line	:	2590 N READING RD
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517-9153
Country	:	US
Telephone Number	:	717-484-2649
Fax Number	:	717-484-6056

Provider Business Practice Location Address
First Line	:	2590 N READING RD
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517-9153
Country	:	US
Telephone Number	:	717-484-2649
Fax Number	:	717-484-6056

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE ANN WISNIEWSKI
Credential	:
Telephone Number	:	215-260-4460

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	08/07/2025

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Directions to “TERRANOVA RX ” Practice Location

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