Healthcare Provider Details

I. General information

NPI: 1508110024
Provider Name (Legal Business Name): SCOTT WERTZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PERKIOMEN AVE
READING PA
19602-1349
US

IV. Provider business mailing address

1170 PERKIOMEN AVE
READING PA
19602-1349
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-1396
  • Fax: 610-378-5529
Mailing address:
  • Phone: 610-378-1396
  • Fax: 610-378-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPP410055L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2137685
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: SCOTT WERTZ
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 610-378-1396