Provider Demographics
NPI:1104291707
Name:MANCHESTER PHARMACY & MEDICAL
Entity type:Organization
Organization Name:MANCHESTER PHARMACY & MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIKERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-978-5142
Mailing Address - Street 1:4310 N GEORGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1307
Mailing Address - Country:US
Mailing Address - Phone:717-978-5142
Mailing Address - Fax:717-978-5126
Practice Address - Street 1:4310 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1307
Practice Address - Country:US
Practice Address - Phone:717-978-5142
Practice Address - Fax:717-978-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PAPP482601333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155639OtherPK
PA103073390Medicaid