MEDICARE: DEREK PASKAITIS RPH

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	RP042477L	PA

General Provider Information

NPI Number	:	1184074247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK PASKAITIS RPH

Provider Business Mailing Address
First Line	:	4013 FARGREEN RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3119
Country	:	US
Telephone Number	:	717-232-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	3913 HARTZDALE DR
Second Line	:	SUITE 1306
City	:	CAMP HILL
State	:	PA
Zip	:	17011-7845
Country	:	US
Telephone Number	:	717-695-9082
Fax Number	:	717-695-9657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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