Kresge Lebar Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

PP411345L Issued in PA

Legal business name

KRESGE LEBAR PHARMACY

Doing business as

Beta Property Enterprises, Inc

Practice address

425 Main St
Stroudsburg, PA 18360-2462

Phone

(570) 421-0710

Fax

(570) 421-3405

NPI assigned

Jul 14, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Mattins Prickisie

Title

Store Manager

Phone

(570) 421-0710

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beta Property Enterprises, Inc Doing business as

Locations

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750380564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MAIN ST",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183602462",
            "telephone_number": "570-421-0710",
            "fax_number": "570-421-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 MAIN ST",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183602462",
            "telephone_number": "570-421-0710",
            "fax_number": "570-421-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRESGE LEBAR PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRICKISIE",
        "authorized_official_first_name": "MATTINS",
        "authorized_official_title_or_position": "STORE MANAGER",
        "authorized_official_telephone_number": "570-421-0710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "PP411345L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011208930001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beta Property Enterprises, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Kneisly
• Tina M Knorr
• Sebastian Konefal
• Nicole Kozma, PA-C
• Job M. Kreiling, PHARM.D.
• Jodi Renee Kresge, M.S., CCC-SLP
• Ann Marie Kriebel, PTA
• Sandra M Krokos, OD
• Kathleen A Kwasny, R.N.
• Melissa Marie Lane, CRNP

• Pharmacist in Stroudsburg, PA
• Providers in Stroudsburg, PA by specialty
• Pharmacist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.