Bracey'S Mount Pocono, Inc.
Organization Active NPI Community/Retail Pharmacy · Mount Pocono, PA
NPI 1851476949 · NPPES record last updated Mar 30, 2011
Key facts
- NPI
- 1851476949
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PP481373 (PA)
- Legal business name
- BRACEY'S MOUNT POCONO, INC.
- Practice address
- 89 State Route 940
Mount Pocono, PA 18344-1426 - Phone
- (570) 839-5340
- NPI assigned
- Oct 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Melissa Figueroa-Rivera
- Title
- Third Party Administrator
- Phone
- (732) 521-8439
Practitioners 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930022556 | PA | DME Supplier - Pharmacy |
7214146083 | Practice locations: Mount Pocono, PA |
| O20110919000659 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214146083 | Practice locations: Mount Pocono, PA |
National Provider Directory
Locations
3430 Route 940
Ste 102
Mount Pocono, PA 18344
Phone (570) 839-5340
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PP481373 | PA | Yes |
Addresses
Primary practice location
89 State Route 940
Mount Pocono, PA 18344-1426
Mailing address
921 Drinker Tpke
Covington Township, PA 18444-7947
Phone (570) 842-7461
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009983850001 | Medicaid | PA | |
| 3983233 | Other | NCPDP |
Other names
- Bill's Shoprite Pharmacy Mt. Pocono
Other providers in Mount Pocono, PA
- Makenzie Elizabeth Batt
- Lori Eileen Bertanzetti
- Best Vision Center Inc
- Paul W. Bisio
- Sylvia M. Bolock
- Lisa Brown
- William Michael Burkit
- Ishima Q Butler
- Debora T Cantel
- Margurita M Carter
All providers in Mount Pocono, PA · Community/Retail Pharmacy in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.