NPIMap

Organization Active NPI

Salem Crossroads Apothecary LLC

Doing business as Salem Crssrds Apothecary

  • Community/Retail Pharmacy
  • Delmont, PA
National Provider Identifier
1386723054
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP410636L Issued in PA
Legal business name
SALEM CROSSROADS APOTHECARY LLC
Doing business as
Salem Crssrds Apothecary
Practice address
195 Sheffield Dr Ste B
Delmont, PA 15626-1744
Phone
(724) 468-5565
Fax
(724) 468-8336
NPI assigned
Nov 3, 2006
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Dennis James KieselNPI 1184331001
Title
Owner
Phone
(724) 468-5565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PP410636L PA Primary

Addresses

Primary practice location

195 Sheffield Dr Ste B
Delmont, PA 15626-1744

Mailing address

195 Sheffield Dr Ste B
Delmont, PA 15626-1744
Phone (724) 468-5565

Other identifiers 2

IdentifierTypeStateIssuer
1042405450001MedicaidPA
2082625OtherPK

Other names 1

  • SALEM CRSSRDS APOTHECARY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231108003570 PA Part B Supplier - Mass Immunization (Roster Biller Only) 7618324864 Practice locations: Delmont, PA
O20231117000585 PA Part B Supplier - Pharmacy 7618324864 Practice locations: Delmont, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1386723054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 SHEFFIELD DR STE B",
            "city": "DELMONT",
            "state": "PA",
            "postal_code": "156261744",
            "telephone_number": "724-468-5565",
            "fax_number": "724-468-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 SHEFFIELD DR STE B",
            "city": "DELMONT",
            "state": "PA",
            "postal_code": "156261744",
            "telephone_number": "724-468-5565",
            "fax_number": "724-468-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM CROSSROADS APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "KIESEL",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-468-5565"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP410636L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1042405450001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2082625",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SALEM CRSSRDS APOTHECARY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SALEM CRSSRDS APOTHECARY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Delmont, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.