Shady Maple Pharmacy

LBN: Shady Maple Pharmacy
Shady Maple Pharmacy is an health care organization with primary practice located at 1324 Main St , East Earl PA 17519-9508. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shady Maple Pharmacy can be contacted via phone (717) 355-9424, or through Evans, Roy via phone (717) 355-9424.

Contact Information

Primary practice address
1324 Main St East Earl PA 17519-9508
Phone: (717) 355-9424
Fax: (717) 351-0253
Website:
Map and Directions
Authorized official contact:
Name: Evans, Roy RPH
Phone: (717) 355-9424

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PP481512 Pennsylvania

Profile Details

NPI number 1932145950
LBN Legal business name Shady Maple Pharmacy
DBA Doing business as Shady Maple Pharmacy
Authorized official Evans, Roy RPH
Entity Organization
Organization subpart 1 No
Enumeration date Jun 20th, 2006
Last updated Dec 14th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932145950 NPPES
Other 2087490 PK
MEDICAID 1014656950001 PK

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