Healthcare Provider Details

I. General information

NPI: 1801870431
Provider Name (Legal Business Name): MYKOLA JOHN SALATA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MAIN ST
HELLERTOWN PA
18055-1726
US

IV. Provider business mailing address

3568 MAGNOLIA DR
EASTON PA
18045-3019
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-0411
  • Fax: 610-838-6780
Mailing address:
  • Phone: 610-258-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030239L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: