Healthcare Provider Details

I. General information

NPI: 1669829883
Provider Name (Legal Business Name): JOHN ZAGORSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S MAIN AVE
SCRANTON PA
18504-3216
US

IV. Provider business mailing address

1510 S MAIN AVE
SCRANTON PA
18504-3216
US

V. Phone/Fax

Practice location:
  • Phone: 570-969-4922
  • Fax: 570-969-4933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029731L
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: