Healthcare Provider Details

I. General information

NPI: 1477604510
Provider Name (Legal Business Name): MYKOLA J SALATA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MAIN ST
HELLERTOWN PA
18055-1726
US

IV. Provider business mailing address

PO BOX 133
HELLERTOWN PA
18055-0133
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412962L
License Number StatePA

VIII. Authorized Official

Name: MR. MYKOLA J SALATA
Title or Position: PHARMACIST OWNER
Credential:
Phone: 610-838-0411