NPIMap

Organization Active NPI

Redner's Markets, Inc.

Doing business as Redner's Pharmacy #22

  • Pharmacy
  • Shenandoah, PA
National Provider Identifier
1649275835
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PP481111 Issued in PA
Legal business name
REDNER'S MARKETS, INC.
Doing business as
Redner's Pharmacy #22
Practice address
3 Gold Star PLZ
Shenandoah, PA 17976-2530
Phone
(570) 462-9651
Fax
(570) 462-3272
NPI assigned
Jun 15, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mr. Donald J Veglia, RPH
Title
Pharmacy Manager
Phone
(570) 462-9651

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PP481111L PA
Pharmacy 333600000X PP481111 PA Primary

Addresses

Primary practice location

3 Gold Star PLZ
Shenandoah, PA 17976-2530

Mailing address

3 Gold Star PLZ
Shenandoah, PA 17976-2530
Phone (570) 462-9651

Other identifiers 2

IdentifierTypeStateIssuer
1007522960009MedicaidPA
3980035OtherNABP NUMBER

Other names 1

  • Redner's Pharmacy #22 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930024024 PA DME Supplier - Pharmacy 3274653670 Practice locations: Shenandoah, PA
O20110317000605 PA Part B Supplier - Mass Immunization (Roster Biller Only) 3274653670 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shenandoah, PA; Palmyra, PA; Hegins, PA; Fredericksburg, PA; Leesport, PA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Redners Markets Inc3 Gold Star PLZ, Shenandoah, PA 17976-2530(570) 462-9651 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Nebulizer Equipment and/or Supplies|Surgical Dressings Accepts assignmentParticipating since Jan 11, 2002

National Provider Directory

National Provider Directory
Tax ID family
Redners Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

3 Gold Star Plz
Shenandoah, PA 17976
Phone (570) 462-9651

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1649275835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 GOLD STAR PLZ",
            "city": "SHENANDOAH",
            "state": "PA",
            "postal_code": "179762530",
            "telephone_number": "570-462-9651",
            "fax_number": "570-462-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 GOLD STAR PLZ",
            "city": "SHENANDOAH",
            "state": "PA",
            "postal_code": "179762530",
            "telephone_number": "570-462-9651",
            "fax_number": "570-462-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDNER'S MARKETS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "VEGLIA",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "570-462-9651",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "PP481111L",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP481111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007522960009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "3980035",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redner's Pharmacy #22",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, PA

Sources for this page

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