Healthcare Provider Details

I. General information

NPI: 1033974464
Provider Name (Legal Business Name): SINCLAIR MOUNTAIN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SULLIVAN ST
CANTON PA
17724-1733
US

IV. Provider business mailing address

121 SULLIVAN ST
CANTON PA
17724-1733
US

V. Phone/Fax

Practice location:
  • Phone: 570-673-4372
  • Fax: 570-673-7247
Mailing address:
  • Phone: 570-673-7247
  • Fax: 570-673-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449212
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: