Healthcare Provider Details

I. General information

NPI: 1336200187
Provider Name (Legal Business Name): RURAL HEALTH CORP PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 SR 29 S SUITE 2
MONROE TWP PA
18636
US

IV. Provider business mailing address

2888 SR 28 S SUITE 2
MONROE TWP PA
18636
US

V. Phone/Fax

Practice location:
  • Phone: 570-298-2121
  • Fax:
Mailing address:
  • Phone: 570-298-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410885L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3943873
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNABP NUMBER

VIII. Authorized Official

Name: MATTHEW J ISKRA
Title or Position: CFO
Credential: MBA
Phone: 570-825-8741