Healthcare Provider Details

I. General information

NPI: 1972082022
Provider Name (Legal Business Name): HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E WYOMISSING AVE STE H
MOHNTON PA
19540-1523
US

IV. Provider business mailing address

29 E MAIN ST
GOUVERNEUR NY
13642-1401
US

V. Phone/Fax

Practice location:
  • Phone: 610-743-3132
  • Fax: 610-741-6348
Mailing address:
  • Phone: 315-287-3600
  • Fax: 315-287-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STACEY KRUTH
Title or Position: VP FINANCE
Credential:
Phone: 315-778-7651