Provider Demographics
NPI:1730248279
Name:STEELTON PHARMACY LLC
Entity type:Organization
Organization Name:STEELTON PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-534-1300
Mailing Address - Street 1:15 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113
Mailing Address - Country:US
Mailing Address - Phone:717-985-1300
Mailing Address - Fax:717-985-9918
Practice Address - Street 1:15 N FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113
Practice Address - Country:US
Practice Address - Phone:717-985-1300
Practice Address - Fax:717-985-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:2017-07-18
Deactivation Code:
Reactivation Date:2017-08-04
Provider Licenses
StateLicense IDTaxonomies
PAPP481091L3336C0003X
PAPP4810913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1270430003Medicare NSC
PA1007293870005Medicaid