Healthcare Provider Details

I. General information

NPI: 1235616905
Provider Name (Legal Business Name): SCRANTON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MULBERRY ST
SCRANTON PA
18503-1230
US

IV. Provider business mailing address

1656 ROUTE 209 UNIT 6
BRODHEADSVILLE PA
18322-7819
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-7828
  • Fax: 570-344-8078
Mailing address:
  • Phone: 570-801-7886
  • Fax: 570-801-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482803
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: UMESH PATEL
Title or Position: PRESIDENT
Credential:
Phone: 484-274-5428