Provider Demographics
NPI:1992791834
Name:SACRED HEART ANCILLARY SERVICES
Entity type:Organization
Organization Name:SACRED HEART ANCILLARY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:610-776-4979
Mailing Address - Street 1:451 W CHEW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3472
Mailing Address - Country:US
Mailing Address - Phone:610-776-4999
Mailing Address - Fax:
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-776-4999
Practice Address - Fax:610-776-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413823L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0440230002Medicare ID - Type Unspecified