Healthcare Provider Details

I. General information

NPI: 1184601312
Provider Name (Legal Business Name): TABLETT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N SHAMOKIN ST
SHAMOKIN PA
17872
US

IV. Provider business mailing address

605 N SHAMOKIN ST
SHAMOKIN PA
17872
US

V. Phone/Fax

Practice location:
  • Phone: 570-648-5242
  • Fax: 570-648-3606
Mailing address:
  • Phone: 570-648-5242
  • Fax: 570-648-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414448L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS A BRADLEY
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-648-5242