Provider Demographics
NPI:1538163571
Name:SHADELAND PHARMACY
Entity type:Organization
Organization Name:SHADELAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CHEIF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-259-1233
Mailing Address - Street 1:403 SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1437
Mailing Address - Country:US
Mailing Address - Phone:610-259-1233
Mailing Address - Fax:610-622-4799
Practice Address - Street 1:403 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1437
Practice Address - Country:US
Practice Address - Phone:610-259-1233
Practice Address - Fax:610-622-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411528L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy