Southern Tier Home Infusion Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481320 Issued in PA

Legal business name

SOUTHERN TIER HOME INFUSION INC

Doing business as

Pharmacy Innovations

Practice address

2936 W 17TH St
Erie, PA 16505-3929

Phone

(814) 838-2102

Fax

(716) 708-6248

NPI assigned

Apr 25, 2007

Last updated

Jul 13, 2022By 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

Richard Moon, PHARMD

Title

Owner

Phone

(716) 720-5121

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• PHARMACY INNOVATIONS Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Pharmacy Innovations3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Tier Home Infusion Inc

  dba Pharmacy Innovations

  • Community/Retail Pharmacy
  • Houston, TX
  • NPI 1891940391
  NPD tax ID
• Southern Tier Infusion Inc

  dba Pharmacy Innovations

  • Community/Retail Pharmacy
  • Spring, TX
  • NPI 1245386689
  NPD tax ID

Locations

Practitioners 3

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.

• Kathryn Elisabeth Wilkosz, PHARMD

  • Pharmacist
  • Erie, PA
  • NPI 1770174914
  NPD
• Alison Burkholder, PHARMD

  • Pharmacist
  • Erie, PA
  • NPI 1003330804
  NPD (past)
• Taylor Scully

  • Pharmacist
  • Stoughton, MA
  • NPI 1104370485
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1629297718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 JOHNS PL",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147019210",
            "telephone_number": "716-720-5121",
            "fax_number": "716-708-6248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2936 W 17TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053929",
            "telephone_number": "814-838-2102",
            "fax_number": "716-708-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN TIER HOME INFUSION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-720-5121",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481320",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1036178670001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2086805",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHARMACY INNOVATIONS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHARMACY INNOVATIONS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Autumn Sorenson, SLP
• Peter C Sotus, M.D.
• Soul Blossom LLC
• Richard Francis Soule, LICENSE SOCIAL WORKE
• Nicholas John Sousanidis, PT, DPT
• Southern Tier Optometric Center Inc (Council Optometric Center)
• Southerncare, Inc. (Heartland)
• Jeffrey James Spaeder
• Sparrowsong Counseling Services, LLC
• Lindy Hope Spear

• Community/Retail Pharmacy in Erie, PA
• Providers in Erie, 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 13, 2022; 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.