Healthcare Provider Details

I. General information

NPI: 1548230105
Provider Name (Legal Business Name): SALLY ANN TICE PHARM.D., MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER MEDICAL CENTER PHARMACY DEPT 42-01 100 N ACADEMY AVE
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

157 STEIN RD
ASHLAND PA
17921-9240
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6691
  • Fax: 570-271-7278
Mailing address:
  • Phone: 570-875-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP035523L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: