NPIMap

Organization Active NPI

Department of Military Affairs Commonwealth of Pennsylvania

  • Long Term Care Pharmacy
  • Scranton, PA
National Provider Identifier
1104181189
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA
Practice address
401 Penn Ave
Scranton, PA 18503-1213
Phone
(570) 961-4300
NPI assigned
Jul 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Reed Jr.
Title
Fiscal Services Administrator
Phone
(814) 242-7789

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X HP418379L PA
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

401 Penn Ave
Scranton, PA 18503-1213

Mailing address

401 Penn Ave
Scranton, PA 18503-1213

Other names 1

  • Gino Merli Veterans' Center Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120919000056 PA Part B Supplier - Pharmacy 1557320348 5 other NPIs on this enrollment
Practice locations: Spring City, PA; Scranton, PA; Pittsburgh, PA; Erie, PA; Duncansville, PA; Philadelphia, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ilhoon Kim12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

401 Penn Ave
Scranton, PA 18503
Phone (570) 961-4300

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1104181189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 PENN AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185031213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PENN AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185031213",
            "telephone_number": "570-961-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-06",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "FISCAL SERVICES ADMINISTRATOR",
        "authorized_official_telephone_number": "814-242-7789",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "HP418379L",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gino Merli Veterans' Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gino Merli Veterans' Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.