Organization
MAIN STREET DRUG STORE INC
Active
Other names
Everett Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN ISEMINGER (AUTHORIZED OFFICIAL)
(814) 652-5532
Entity
Organization
Contact information
Practice address
108 E MAIN ST, EVERETT, PA 15537-1258
(814) 652-5532
(814) 652-2927
Mailing address
108 E MAIN ST, EVERETT, PA 15537-1258
(814) 652-5532
(814) 652-2927
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP410712L
PA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022770360001
—
PA
01
—
3991761
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
559319
—
PA
Enumeration date
02/13/2009
Last updated
12/19/2012
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