Healthcare Provider Details

I. General information

NPI: 1922577675
Provider Name (Legal Business Name): STEPHANI LYNN OHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NORTHERN BLVD
SOUTH ABINGTON TOWNSHIP PA
18411-2220
US

IV. Provider business mailing address

1507 EUCLID AVE
SCRANTON PA
18504-1267
US

V. Phone/Fax

Practice location:
  • Phone: 570-587-2460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443939
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: