Healthcare Provider Details

I. General information

NPI: 1134032766
Provider Name (Legal Business Name): SARA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 TEXAS PALMYRA HWY
HONESDALE PA
18431-7678
US

IV. Provider business mailing address

14 HORIZON VW
HONESDALE PA
18431-3239
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-1620
  • Fax: 570-253-1716
Mailing address:
  • Phone: 570-253-1620
  • Fax: 570-253-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30262267
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: