Healthcare Provider Details

I. General information

NPI: 1093096430
Provider Name (Legal Business Name): JEFFREY P ZYMBLOSKY PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 LINDEN ST
SCRANTON PA
18503-1605
US

IV. Provider business mailing address

539 LINDEN ST
SCRANTON PA
18503-1605
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8936
  • Fax: 570-343-1455
Mailing address:
  • Phone: 570-342-8936
  • Fax: 570-343-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444669
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPI002256
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: