Provider Demographics
NPI:1306973391
Name:VACCARE PHARMACY , INC
Entity type:Organization
Organization Name:VACCARE PHARMACY , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-837-1260
Mailing Address - Street 1:110 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2404
Mailing Address - Country:US
Mailing Address - Phone:724-827-1260
Mailing Address - Fax:724-837-1261
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2404
Practice Address - Country:US
Practice Address - Phone:724-827-1260
Practice Address - Fax:724-837-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412753L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011299110001Medicaid