Provider Demographics
NPI:1487055984
Name:REDNER'S MARKETS INC.
Entity type:Organization
Organization Name:REDNER'S MARKETS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT/COMPLIANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-248-5873
Mailing Address - Street 1:110 NORTHSIDE COMMONS
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8663
Mailing Address - Country:US
Mailing Address - Phone:717-473-4054
Mailing Address - Fax:717-473-4051
Practice Address - Street 1:110 NORTHSIDE COMMONS
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-8663
Practice Address - Country:US
Practice Address - Phone:717-473-4054
Practice Address - Fax:717-473-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007522960013Medicaid
PA0997350007Medicare NSC