Healthcare Provider Details

I. General information

NPI: 1720129299
Provider Name (Legal Business Name): JUDITH ZOCK CASEY R PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 MAIN ST
PORTAGE PA
15946-1539
US

IV. Provider business mailing address

174 APPLE DR
CRESSON PA
16630-1654
US

V. Phone/Fax

Practice location:
  • Phone: 814-736-4530
  • Fax:
Mailing address:
  • Phone: 814-886-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029958L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: