Vandergrift Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP411945L Issued in PA

Legal business name

VANDERGRIFT PHARMACY LLC

Doing business as

Vandergrift Health Mart Pharmacy

Practice address

224 Longfellow St Ste 100
Vandergrift, PA 15690-1476

Phone

(724) 567-6615

Fax

(724) 568-1608

NPI assigned

Oct 21, 2006

Last updated

Jul 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bretton Walberg, R.PH.NPI 1659809374

Title

President

Phone

(724) 612-2131

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Vandergrift Health Mart Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bretton Clark Walberg, RPH

  • Pharmacist
  • Greenville, PA
  • NPI 1659809374
  Authorized official Same address or phone
• Alexander J Micklow, R.PH.

  • Pharmacist
  • Leechburg, PA
  • NPI 1417030875
  NPD (past)

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783987200000",
    "number": "1285717637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CONNEAUT LAKE RD",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "161252167",
            "telephone_number": "724-567-6615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 LONGFELLOW ST STE 100",
            "city": "VANDERGRIFT",
            "state": "PA",
            "postal_code": "156901476",
            "telephone_number": "724-567-6615",
            "fax_number": "724-568-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERGRIFT PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A",
        "authorized_official_last_name": "WALBERG",
        "authorized_official_first_name": "BRETTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-612-2131",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "PP411945L",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP411945L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3942100",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007627200001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vandergrift Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vandergrift Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lori Michele Shotts, CRNP
• Shri Hari Pharmacy LLC (Ross Grant Ave. Pharmacy)
• Timothy J Sluser, DMD
• Paul A Tallarom, R.PH.
• Vandergrift Fire Department No 2
• Myron Webb Jr.
• Larry Earl Wise, DMD
• Charles W Yakulis, DMD

• Community/Retail Pharmacy in Vandergrift, PA
• Providers in Vandergrift, 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 14, 2026; 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.