| Millcreek Manor Vaccine Program | |
|
5535 Peach St Erie PA 16509-2603 | |
| (814) 868-2496 | |
| (814) 868-2581 |
| Full Name | Millcreek Manor Vaccine Program |
|---|---|
| Speciality | Pharmacy |
| Location | 5535 Peach St, Erie, Pennsylvania |
| Authorized Official Name and Position | Joshua a Beerbower (CFO) |
| Authorized Official Contact | 8144884825 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Millcreek Manor Vaccine Program 5535 Peach St Erie PA 16509-2603 Ph: (814) 868-2496 | Millcreek Manor Vaccine Program 5535 Peach St Erie PA 16509-2603 Ph: (814) 868-2496 |
| NPI Number | 1588272884 |
|---|---|
| Provider Enumeration Date | 07/22/2020 |
| Last Update Date | 06/11/2025 |
| Certification Date | 06/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588272884 | NPI | - | NPPES |
| 0012079290002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 333600000X | Pharmacy | () | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | () | Secondary |
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