MEDICARE: DR. SALLY ANN TICE PHARM.D., MHA

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	1835P1200X	Pharmacotherapy Pharmacist	RP035523L	PA

General Provider Information

NPI Number	:	1548230105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY ANN TICE PHARM.D., MHA

Provider Business Mailing Address
First Line	:	157 STEIN RD
Second Line	:
City	:	ASHLAND
State	:	PA
Zip	:	17921-9240
Country	:	US
Telephone Number	:	570-875-2681
Fax Number	:

Provider Business Practice Location Address
First Line	:	GEISINGER MEDICAL CENTER PHARMACY DEPT 42-01
Second Line	:	100 N ACADEMY AVE
City	:	DANVILLE
State	:	PA
Zip	:	17822-0001
Country	:	US
Telephone Number	:	570-271-6691
Fax Number	:	570-271-7278

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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