Healthcare Provider Details

I. General information

NPI: 1124156450
Provider Name (Legal Business Name): TWIN TIER MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date: 07/07/2009
Reactivation Date: 08/24/2009

III. Provider practice location address

7 COLONIAL DRIVE
TOWANDA PA
18848
US

IV. Provider business mailing address

7 COLONIAL DRIVE
TOWANDA PA
18848
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-0659
  • Fax: 570-265-0624
Mailing address:
  • Phone: 570-265-0659
  • Fax: 570-265-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481272
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JOHN L NESPOLI
Title or Position: PRESIDENT
Credential:
Phone: 570-882-4317