NPIMap

Organization Active NPI

Millcreek Manor Pharmacy

Doing business as LECOM Senior Living Center Pharmacy

  • Long Term Care Pharmacy
  • Erie, PA
National Provider Identifier
1114393790
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PP482569 Issued in PA
Legal business name
MILLCREEK MANOR PHARMACY
Doing business as
LECOM Senior Living Center Pharmacy
Practice address
5535 Peach St
Erie, PA 16509-2603
Phone
(814) 868-3869
Fax
(814) 868-3405
NPI assigned
Aug 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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

Authorized official

Name
Jaime Babiak
Title
Director of Pharmacy
Phone
(814) 868-3880

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X PP482569 PA Primary

Addresses

Primary practice location

5535 Peach St
Erie, PA 16509-2603

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 868-3869

Other identifiers 1

IdentifierTypeStateIssuer
2151152OtherPK

Other names 1

  • LECOM Senior Living Center Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lecom Home Care12 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

5535 Peach St
Erie, PA 16509
Phone (814) 868-3488

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1114393790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-868-3869",
            "fax_number": "814-868-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-868-3869",
            "fax_number": "814-868-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK MANOR PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "BABIAK",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "814-868-3880"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "PP482569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2151152",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Senior Living Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.