Healthcare Provider Details

I. General information

NPI: 1104953314
Provider Name (Legal Business Name): LEONARD OHARA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARK ST
HONESDALE PA
18431-1445
US

IV. Provider business mailing address

1102 NICHOLAS DR
CLARKS SUMMIT PA
18411-9182
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8163
  • Fax:
Mailing address:
  • Phone: 570-587-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP026439L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: