Healthcare Provider Details

I. General information

NPI: 1376558924
Provider Name (Legal Business Name): SANDTS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 209 MONROE PLAZA
BRODHEADSVILLE PA
18322
US

IV. Provider business mailing address

6 W PENNSYLVANIA AVE
PEN ARGYL PA
18072-2003
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-4112
  • Fax: 570-992-3618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413400L
License Number StatePA

VIII. Authorized Official

Name: PETER GROBLEWSKI
Title or Position: OWNER
Credential:
Phone: 610-863-5535