Chestnut Ridge Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481172 Issued in PA

Legal business name

CHESTNUT RIDGE PHARMACY LLC

Practice address

2262 Quaker Valley Rd
Fishertown, PA 15539

Phone

(814) 839-9950

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Scott Waugerman

Title

Owner

Phone

(814) 839-9950

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1184787889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95",
            "city": "FISHERTOWN",
            "state": "PA",
            "postal_code": "155390095",
            "telephone_number": "814-839-9950",
            "fax_number": "814-839-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2262 QUAKER VALLEY RD",
            "city": "FISHERTOWN",
            "state": "PA",
            "postal_code": "15539",
            "telephone_number": "814-839-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT RIDGE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "WAUGERMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-839-9950"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01917280",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David R Bowser III, DMD
• Chestnut Ridge School District
• Beth A Clark, DO
• Roben L Egolf, ASSISTANT
• Karen M Leppert
• Milestone Physical Therapy, LLC

• Community/Retail Pharmacy in Fishertown, PA
• Providers in Fishertown, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.