The Vaccine Shoppe, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

THE VACCINE SHOPPE, LLC

Practice address

205 Butler St
Pittston, PA 18640

Phone

(570) 762-9132

NPI assigned

Feb 14, 2022

Organization subpart

No

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

Authorized official

Name

Jude Polit-Moran

Title

President

Phone

(570) 718-8406

Specialties & licenses 1

Addresses

Tax ID family

The Vaccine Shoppe LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The Vaccine Shoppe, LLC

  • Community Health Clinic/Center
  • Pittston, PA
  • NPI 1336895796
  NPD tax ID

Locations

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1194470682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BUTLER ST",
            "city": "PITTSTON",
            "state": "PA",
            "postal_code": "18640",
            "telephone_number": "570-762-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BUTLER ST",
            "city": "PITTSTON",
            "state": "PA",
            "postal_code": "18640",
            "telephone_number": "570-762-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VACCINE SHOPPE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "POLIT-MORAN",
        "authorized_official_first_name": "JUDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-718-8406"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-Pharmacy Dispensing Site in Pittston, PA
• Providers in Pittston, PA by specialty
• Non-Pharmacy Dispensing Site in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; 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.