Healthcare Provider Details

I. General information

NPI: 1033252523
Provider Name (Legal Business Name): STERLING PHARMACY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 WASHINGTON AVE
JERMYN PA
18433
US

IV. Provider business mailing address

547 WASHINGTON AVE
JERMYN PA
18433-1610
US

V. Phone/Fax

Practice location:
  • Phone: 570-876-4412
  • Fax: 570-876-4413
Mailing address:
  • Phone: 570-876-4412
  • Fax: 570-876-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410957L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001072470-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MELISSA DRISCOLL
Title or Position: PRESIDENT
Credential:
Phone: 570-876-4412