Healthcare Provider Details

I. General information

NPI: 1780985077
Provider Name (Legal Business Name): CHEM RX PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BR 209 & BOSSARDSVILLE RD
SCIOTA PA
18354
US

IV. Provider business mailing address

BR 209 & BOSSARDSVILLE RD
SCIOTA PA
18354
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-6300
  • Fax: 570-402-2900
Mailing address:
  • Phone: 570-992-6300
  • Fax: 570-402-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPENDING
License Number StatePA

VIII. Authorized Official

Name: THOMAS CANERIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-627-7100