Healthcare Provider Details

I. General information

NPI: 1437743150
Provider Name (Legal Business Name): ALYSSA KORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEIS PLZ
NANTICOKE PA
18634-1618
US

IV. Provider business mailing address

51 FAIRLAWN AVE
CARBONDALE PA
18407-2525
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-3979
  • Fax:
Mailing address:
  • Phone: 570-687-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPI121592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: