Healthcare Provider Details

I. General information

NPI: 1326188103
Provider Name (Legal Business Name): PRIMECARE PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ADAMS AVE 2ND FLOOR
SCRANTON PA
18503-1620
US

IV. Provider business mailing address

310 ADAMS AVE 2ND FLOOR
SCRANTON PA
18503-1620
US

V. Phone/Fax

Practice location:
  • Phone: 570-207-6860
  • Fax: 570-207-6368
Mailing address:
  • Phone: 570-207-6860
  • Fax: 570-207-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP481068
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0018760990001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL RUANE
Title or Position: PHARMACIST
Credential: RPH
Phone: 570-207-6860