Healthcare Provider Details

I. General information

NPI: 1033657150
Provider Name (Legal Business Name): WASCHKO PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 N WYOMING ST
HAZLETON PA
18201-5563
US

IV. Provider business mailing address

257 N WYOMING ST
HAZLETON PA
18201-5563
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-2951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028286L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierRP028286L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name: CINDY WASCHKO
Title or Position: PRESIDENT
Credential:
Phone: 570-454-2951