Antietam Apothecary Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP412558L Issued in PA

Legal business name

ANTIETAM APOTHECARY INC

Doing business as

Antietam Pharmacy
Waynesboro Apothecary

Practice address

604 E Main St
Waynesboro, PA 17268-2387

Phone

(717) 762-2915

Fax

(717) 762-2357

NPI assigned

Oct 31, 2005

Last updated

Oct 7, 2024By 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

Robert Norris IIINPI 1851279806

Title

Officer

Phone

(717) 504-2159

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• ANTIETAM PHARMACY Doing business as
• Waynesboro Apothecary Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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.

• Robert Andreas Norris III, RPH

  • Pharmacist
  • Waynesboro, PA
  • NPI 1851279806
  Authorized official Same address or phone
• David Riley, M.B.A.

  • Pharmacist
  • Waynesboro, PA
  • NPI 1790834521
  NPD

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1326039249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 E MAIN ST",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682387",
            "telephone_number": "717-762-2915",
            "fax_number": "717-762-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 E MAIN ST",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682387",
            "telephone_number": "717-762-2915",
            "fax_number": "717-762-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIETAM APOTHECARY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2024-10-07",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "717-504-2159",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP412558L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3950070",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001017808",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANTIETAM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ANTIETAM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waynesboro Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Carranda M Barkdoll, C.R.N.P.

• Community/Retail Pharmacy in Waynesboro, PA
• Providers in Waynesboro, 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 Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.