Organization
MEDICINE MAN INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT REIVER RPH (OWNER)
(215) 663-1755
Entity
Organization
Contact information
Practice address
400 HUNTINGDON PIKE, SUITE A, ROCKLEDGE, PA 19046-4431
(215) 663-1755
(215) 663-1737
Mailing address
400 HUNTINGDON PIKE, SUITE A, ROCKLEDGE, PA 19046-4431
(215) 663-1755
(215) 663-1737
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP413738L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011917580000
—
PA
01
—
3959484
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/15/2006
Last updated
02/03/2012
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