Healthcare Provider Details

I. General information

NPI: 1447855358
Provider Name (Legal Business Name): MARTHA TEKLA HIGGS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA TEKLA ZULAWSKI RPH

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 S MAIN ST
SCRANTON PA
18517-2104
US

IV. Provider business mailing address

1008 S MAIN ST
SCRANTON PA
18517-2104
US

V. Phone/Fax

Practice location:
  • Phone: 570-347-7339
  • Fax: 570-347-6940
Mailing address:
  • Phone: 570-347-7339
  • Fax: 570-347-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033799L
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: