MEDICARE: MISS DARIA HELEN SULLA PHARMD., MBA

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	RP441030	PA

General Provider Information

NPI Number	:	1598039968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DARIA HELEN SULLA PHARMD., MBA

Provider Business Mailing Address
First Line	:	1011 SCRANTON CARBONDALE HWY
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1127
Country	:	US
Telephone Number	:	570-489-4274
Fax Number	:	570-489-1834

Provider Business Practice Location Address
First Line	:	1011 SCRANTON CARBONDALE HWY
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1127
Country	:	US
Telephone Number	:	570-489-4274
Fax Number	:	570-489-1834

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

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	04/25/2012

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