Organization
NELLS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL GRANGER (PHARMACY SUPERVISOR)
(610) 678-8867
Entity
Organization
Contact information
Practice address
1424 BALTIMORE ST, HANOVER, PA 17331-8529
(717) 637-1075
(717) 637-3625
Mailing address
1424 BALTIMORE ST, HANOVER, PA 17331-8529
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP415171L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01587407
—
PA
01
—
1007781580010
MEDICAID 2
PA
01
—
3971719
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/27/2006
Last updated
11/09/2010
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