Derry Street Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

PP482814 Issued in PA

Legal business name

DERRY STREET PHARMACY LLC

Practice address

1304 Derry St
Harrisburg, PA 17104-1184

Phone

(717) 547-6219

NPI assigned

Aug 31, 2018

Last updated

Jan 5, 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

Raju Katla, RPH

Title

Pharmacy Manager

Phone

(717) 547-6219

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1386126803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 DERRY ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041184",
            "telephone_number": "717-547-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 DERRY ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041184",
            "telephone_number": "717-547-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-31",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "KATLA",
        "authorized_official_first_name": "RAJU",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "717-547-6219",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP482814",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482814",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Francis Deramo, DO
• Jonelle R Derk, CRNP
• Robert Derner Jr.
• Kurstyn T Derr, PA-C
• Derry Psychiatric Services, P.C.
• Desi Home Care of Pennsylvania LLC
• Melinda Desmarais, B.A., BCABA
• Danielle Renee Desseyn, MS, OTR/L
• Cassandra S. Destefano, PA-C
• Emily Dether

• Pharmacy in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.