Healthcare Provider Details

I. General information

NPI: 1487339719
Provider Name (Legal Business Name): JOHNSONS PHARMACY OF HAZLETON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 15TH ST
HAZLETON PA
18201-2783
US

IV. Provider business mailing address

901 W 15TH ST
HAZLETON PA
18201-2783
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-5884
  • Fax: 570-455-1306
Mailing address:
  • Phone: 570-455-5884
  • Fax: 570-455-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. ROBERT JOSEPH HINKLE JR.
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-455-5884