Healthcare Provider Details

I. General information

NPI: 1871881573
Provider Name (Legal Business Name): ETHICAL FACTOR RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 BIRNEY AVE STE 4
AVOCA PA
18641-9523
US

IV. Provider business mailing address

PO BOX 4047
SCRANTON PA
18505-6047
US

V. Phone/Fax

Practice location:
  • Phone: 570-606-3622
  • Fax: 570-371-6317
Mailing address:
  • Phone: 570-606-3622
  • Fax: 570-371-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301009850
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RO00071900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06270
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP482191
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA F TOMCYKOSKI
Title or Position: OWNER
Credential: PHARMD
Phone: 570-606-3622