Provider Demographics
NPI:1679519599
Name:NEWHARD PHARMACY INC
Entity type:Organization
Organization Name:NEWHARD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-262-2677
Mailing Address - Street 1:1001 MAIN ST # A
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1658
Mailing Address - Country:US
Mailing Address - Phone:610-261-1777
Mailing Address - Fax:610-262-8501
Practice Address - Street 1:1001 MAIN ST # A
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1658
Practice Address - Country:US
Practice Address - Phone:610-261-1777
Practice Address - Fax:610-262-8501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWHARD PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4812153336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007473670001Medicaid
2086395OtherPK
PA1007473670001Medicaid