Healthcare Provider Details

I. General information

NPI: 1861574535
Provider Name (Legal Business Name): LYCOMING COUNTY MONTGOMERY'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 N RAILROAD ST
HUGHESVILLE PA
17737-1213
US

IV. Provider business mailing address

49 N RAILROAD ST
HUGHESVILLE PA
17737-1213
US

V. Phone/Fax

Practice location:
  • Phone: 570-584-2005
  • Fax: 570-584-5115
Mailing address:
  • Phone: 570-584-2005
  • Fax: 570-584-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP411615L
License Number StatePA

VIII. Authorized Official

Name: MRS. PAULINE R MONTGOMERY
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-584-2005