Provider Demographics
NPI:1366544140
Name:REDNER'S MARKETS, INC.
Entity type:Organization
Organization Name:REDNER'S MARKETS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT & COMPLIANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:610-926-3129
Mailing Address - Street 1:2977 STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9304
Mailing Address - Country:US
Mailing Address - Phone:717-865-6566
Mailing Address - Fax:717-865-1664
Practice Address - Street 1:2977 STATE ROUTE 22
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9304
Practice Address - Country:US
Practice Address - Phone:717-865-6566
Practice Address - Fax:717-865-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412177L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007522960008Medicaid
3941487OtherNABP
PA0997350002Medicare NSC