Olde Hickory Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP413656L Issued in PA

Legal business name

OLDE HICKORY PHARMACY INC

Practice address

3 Woodhenge Cir
Lititz, PA 17543-9096

Phone

(717) 431-8429

Fax

(717) 569-3807

NPI assigned

Jun 10, 2006

Organization subpart

No

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

Authorized official

Name

Darryl Bon Fessuto, RPHNPI 1811033160

Title

President Ceo Head Pharmacist

Phone

(717) 824-2189

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• OLDE HICKORY PHARMACY INC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darryl M Bonfessuto, R.PH.

  • Pharmacist
  • Lancaster, PA
  • NPI 1811033160
  NPD (past) Authorized official

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320710400000",
    "number": "1669414371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WOODHENGE CIR",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175439096",
            "telephone_number": "717-824-2189",
            "fax_number": "717-569-3807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 WOODHENGE CIR",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175439096",
            "telephone_number": "717-431-8429",
            "fax_number": "717-569-3807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLDE HICKORY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2011-11-08",
        "status": "A",
        "authorized_official_last_name": "BON FESSUTO",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "PRESIDENT CEO HEAD PHARMACIST",
        "authorized_official_telephone_number": "717-824-2189",
        "authorized_official_credential": "RPH"
    },
    "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": "PP413656L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3960526",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205719",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OLDE HICKORY PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gregory Robert James O'Neill, D.C.
• Michele O'Neill, CRNP
• Breanna Marie Ober, PA-C
• Jayme Lyn Ober, OTR/L
• Marlena Okurowski
• Carrie R Olena, HIS
• Brianna Lynn Olivieri, RD
• Leah Michelle Ortiz
• Scott Charles Osborn, DO
• Emory L Otto, PSY.D.

• Community/Retail Pharmacy in Lititz, PA
• Providers in Lititz, 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 Nov 8, 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.

Verify at the official NPI Registry.