MEDICARE: WASCHKO PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP028286L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP028286L	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1033657150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASCHKO PHARMACY

Provider Business Mailing Address
First Line	:	257 N WYOMING ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-5563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	257 N WYOMING ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-5563
Country	:	US
Telephone Number	:	570-454-2951
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CINDY WASCHKO
Credential	:
Telephone Number	:	570-454-2951

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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