Provider Demographics
NPI:1588774749
Name:NELL'S, INC.
Entity type:Organization
Organization Name:NELL'S, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-324-4924
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551
Mailing Address - Country:US
Mailing Address - Phone:610-693-3161
Mailing Address - Fax:610-678-7710
Practice Address - Street 1:1706 SPRING ROAD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-1176
Practice Address - Country:US
Practice Address - Phone:717-249-2285
Practice Address - Fax:717-249-2350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NELL'S, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4814863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3984970OtherOTHER ID NUMBER
PA1007781580015Medicaid
3984970OtherNCPDP
1588774749Medicare PIN
3984970OtherNCPDP
3984970OtherOTHER ID NUMBER