Healthcare Provider Details

I. General information

NPI: 1104847169
Provider Name (Legal Business Name): ROBERT PACKER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ SUITE EC101
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1 GUTHRIE SQ SUITE EC101
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-2800
  • Fax: 570-887-2827
Mailing address:
  • Phone: 570-887-2800
  • Fax: 570-887-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413232L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SHAY
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 570-887-2816