Healthcare Provider Details

I. General information

NPI: 1427961721
Provider Name (Legal Business Name): DYLAN MICHAEL SCULLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S MAIN AVE
SCRANTON PA
18504-2585
US

IV. Provider business mailing address

330 S MAIN AVE
SCRANTON PA
18504-2585
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-1429
  • Fax:
Mailing address:
  • Phone: 570-341-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP460637
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: