Healthcare Provider Details

I. General information

NPI: 1104561091
Provider Name (Legal Business Name): LEHIGH VALLEY HOSPITAL POCONO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MAIN ST
DICKSON CITY PA
18519-1691
US

IV. Provider business mailing address

330 MAIN ST
DICKSON CITY PA
18519-1691
US

V. Phone/Fax

Practice location:
  • Phone: 570-330-5180
  • Fax: 570-330-5024
Mailing address:
  • Phone: 570-330-5180
  • Fax: 570-330-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT THOMAS
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 484-884-0901