Active NPI
Mary Jane Fleck, RPH
- Pharmacist
- Portage, PA
National Provider Identifier
1508158676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP029631L
- Practice address
- 630 Main St
Portage, PA 15946-7107 - Phone
- (814) 736-4323
- Fax
- (814) 736-4081
- NPI assigned
- May 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP029631L | PA | Primary |
| Pharmacist | 183500000X | 0000034087 | TN |
Addresses
Primary practice location
630 Main St
Portage, PA 15946-7107
Mailing address
261 Allen St
Portage, PA 15946-7107
Phone (814) 736-9362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP029631L | PA | MD | Pharmacist |
| 0000034087 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients | |
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Clearfield, PA
- NPI 1508431081
-
- Community/Retail Pharmacy
- Portage, PA
- NPI 1528157278
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304899200000",
"number": "1508158676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "261 ALLEN ST",
"city": "PORTAGE",
"state": "PA",
"postal_code": "159467107",
"telephone_number": "814-736-9362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 MAIN ST",
"city": "PORTAGE",
"state": "PA",
"postal_code": "159467107",
"telephone_number": "814-736-4323",
"fax_number": "814-736-4081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLECK",
"first_name": "MARY",
"middle_name": "JANE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-09",
"last_updated": "2011-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP029631L",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "0000034087",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.