Healthcare Provider Details

I. General information

NPI: 1104814698
Provider Name (Legal Business Name): VIERCINSKI 'S PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E GROVE ST
CLARKS SUMMIT PA
18411-1774
US

IV. Provider business mailing address

100 E GROVE ST
CLARKS SUMMIT PA
18411-1774
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-1961
  • Fax: 570-587-0319
Mailing address:
  • Phone: 570-586-1961
  • Fax: 570-587-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP411526L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017753540001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier3916206
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCPDP #

VIII. Authorized Official

Name: ROBERT JOHN VIERCINSKI
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-586-1961