Healthcare Provider Details

I. General information

NPI: 1033111604
Provider Name (Legal Business Name): PAUL DOMINICK ROCZNIAK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1127
US

IV. Provider business mailing address

102 SEKOL AVE
SCRANTON PA
18504-1035
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-4274
  • Fax: 570-489-1834
Mailing address:
  • Phone: 570-344-3621
  • Fax: 408-869-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035465L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierRP035465L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPHARMACIST LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: