Healthcare Provider Details

I. General information

NPI: 1336691500
Provider Name (Legal Business Name): LYNNETTE GOFFREDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 HUNTER HWY
TUNKHANNOCK PA
18657-8071
US

IV. Provider business mailing address

99 HOTEL LN
UNION DALE PA
18470-7910
US

V. Phone/Fax

Practice location:
  • Phone: 570-836-8071
  • Fax:
Mailing address:
  • Phone: 570-561-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040656L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: