Healthcare Provider Details

I. General information

NPI: 1073519906
Provider Name (Legal Business Name): SHEELEY'S DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/30/2016
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412267L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2130496
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: LORI HART
Title or Position: RPH, PRES
Credential:
Phone: 570-342-8936