Healthcare Provider Details

I. General information

NPI: 1033545967
Provider Name (Legal Business Name): JASON MICHAEL HAPSTAK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
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

1011 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1127
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-4274
  • Fax: 570-489-1834
Mailing address:
  • Phone: 570-489-4274
  • Fax: 570-489-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440221
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierRP440221
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPHARMACY LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: