NPIMap

Organization Active NPI

Centre Crest Pharmacy

  • Long Term Care Pharmacy
  • Bellefonte, PA
National Provider Identifier
1245366137
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
HP416574-L Issued in PA
Legal business name
CENTRE CREST PHARMACY
Practice address
502 E Howard St
Bellefonte, PA 16823-2128
Phone
(814) 355-6890
Fax
(814) 355-6999
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John M. Luckovich, RPH
Title
Pharmacy Manager
Phone
(814) 355-6890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X HP416574-L PA Primary

Addresses

Primary practice location

502 E Howard St
Bellefonte, PA 16823-2128

Mailing address

502 E Howard St
Bellefonte, PA 16823-2128
Phone (814) 355-6890

Other identifiers 2

IdentifierTypeStateIssuer
1007296630006MedicaidPA
HP416574-LOtherPASTATE LICENSE NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Centre County MH-Id-Eida7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245366137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 E HOWARD ST",
            "city": "BELLEFONTE",
            "state": "PA",
            "postal_code": "168232128",
            "telephone_number": "814-355-6890",
            "fax_number": "814-355-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 E HOWARD ST",
            "city": "BELLEFONTE",
            "state": "PA",
            "postal_code": "168232128",
            "telephone_number": "814-355-6890",
            "fax_number": "814-355-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRE CREST PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUCKOVICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "814-355-6890",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "HP416574-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007296630006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "HP416574-L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellefonte, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.