Provider Demographics
NPI:1124679584
Name:HERMITAGE APOTHECARY INC
Entity type:Organization
Organization Name:HERMITAGE APOTHECARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YARZAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-699-1722
Mailing Address - Street 1:1740 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1740 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1862
Practice Address - Country:US
Practice Address - Phone:724-983-8451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICIEN SHOPPE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102327840002Medicaid