Healthcare Provider Details

I. General information

NPI: 1245823764
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-2404
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-6000
  • Fax: 570-703-6001
Mailing address:
  • Phone: 570-703-6000
  • Fax: 570-703-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1007456760041
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierPP483000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPHARMACY LICENSE

VIII. Authorized Official

Name: MICHAEL A EVANS
Title or Position: VP ENTERPRISE PHARMACY
Credential:
Phone: 570-271-6192