Healthcare Provider Details

I. General information

NPI: 1770657223
Provider Name (Legal Business Name): SARA A WASCOVICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PROSPECT AVE
SCRANTON PA
18505-1813
US

IV. Provider business mailing address

RR 4 BOX 4371
MOSCOW PA
18444-9278
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-1168
  • Fax: 570-207-4633
Mailing address:
  • Phone: 570-346-8064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028915L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierRP028915L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: