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
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