Medicine Man Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP413738L Issued in PA

Legal business name

MEDICINE MAN INC

Doing business as

Medicine Shoppe

Practice address

400 Huntingdon Pike
Suite a
Rockledge, PA 19046-4431

Phone

(215) 663-1755

Fax

(215) 663-1737

NPI assigned

Nov 15, 2006

Last updated

Feb 3, 2012By 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

Robert Reiver, RPHNPI 1760075642

Title

Owner

Phone

(215) 663-1755

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICINE SHOPPE Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Robert Reiver

  • Pharmacist
  • Rockledge, PA
  • NPI 1760075642
  NPD Authorized official

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328227200000",
    "number": "1790857597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HUNTINGDON PIKE",
            "address_2": "SUITE A",
            "city": "ROCKLEDGE",
            "state": "PA",
            "postal_code": "190464431",
            "telephone_number": "215-663-1755",
            "fax_number": "215-663-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HUNTINGDON PIKE",
            "address_2": "SUITE A",
            "city": "ROCKLEDGE",
            "state": "PA",
            "postal_code": "190464431",
            "telephone_number": "215-663-1755",
            "fax_number": "215-663-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2012-02-03",
        "status": "A",
        "authorized_official_last_name": "REIVER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-663-1755",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP413738L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011917580000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3959484",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dina M Mastrogiovanni, OTR/L
• Patricia Ann McCalley, CNM
• Sean Patrick McCloskey
• Patricia McGrath, C R N P
• Marie Patricia McTamney, MSPT
• Allison Elizabeth Menard
• Olga Anna Midzak, MPT
• David M Miller, P.T.
• Wessley Monollese, DO
• Jillian Mozitis, RD

• Community/Retail Pharmacy in Rockledge, PA
• Providers in Rockledge, 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 Feb 3, 2012; 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.