Healthcare Provider Details

I. General information

NPI: 1275856148
Provider Name (Legal Business Name): REZK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SOUTH MAIN ST SUITE 100
CARROLLTOWN PA
15722
US

IV. Provider business mailing address

PO BOX 369
CARROLLTOWN PA
15722-0369
US

V. Phone/Fax

Practice location:
  • Phone: 814-344-2200
  • Fax: 814-344-2600
Mailing address:
  • Phone: 814-344-2200
  • Fax: 814-344-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPP481996
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD JOSEPH REZK
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 814-243-4915