Healthcare Provider Details

I. General information

NPI: 1083691786
Provider Name (Legal Business Name): JANICE E OLCESE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W SPRUCE ST
SHAMOKIN PA
17872-5716
US

IV. Provider business mailing address

400 W SPRUCE ST
SHAMOKIN PA
17872-5716
US

V. Phone/Fax

Practice location:
  • Phone: 570-648-7891
  • Fax: 570-648-2007
Mailing address:
  • Phone: 570-648-7891
  • Fax: 570-648-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. JANICE ELLEN OLCESE
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 570-648-7891