Organization
HERMITAGE PHARMACY LLC
Active
Organization
HERMITAGE PHARMACY LLC
Active
Other names
Hermitage Pharmacy, The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRETTON CLARK WALBERG RPH (MEMBER)
(724) 612-2131
Entity
Organization
Contact information
Practice address
1740 E STATE ST, HERMITAGE, PA 16148-1862
(724) 983-8451
(724) 983-0918
Mailing address
30 CONNEAUT LAKE ROAD, GREENVILLE, PA 16125-2167
(724) 612-2131
(724) 983-0918
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP412447L
PA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023278440002
—
PA
05
—
104547785-0001
—
PA
01
—
2083437
PK
—
Enumeration date
09/30/2006
Last updated
10/20/2025
Update your record
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