Healthcare Provider Details

I. General information

NPI: 1164992707
Provider Name (Legal Business Name): PAMELA ANN SERRATORE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEIS PLAZA
NANTICOKE PA
18634
US

IV. Provider business mailing address

121 MARIA DRIVE
WYOMING PA
18644
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-3979
  • Fax: 570-735-4567
Mailing address:
  • Phone: 570-333-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP034682L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: