Healthcare Provider Details

I. General information

NPI: 1154405348
Provider Name (Legal Business Name): EM MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE ROUTE 6
WYALUSING PA
18853-0037
US

IV. Provider business mailing address

PO BOX 37
WYALUSING PA
18853-0037
US

V. Phone/Fax

Practice location:
  • Phone: 570-746-3357
  • Fax: 570-746-3839
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414254L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MIHALEK
Title or Position: MANAGER
Credential:
Phone: 570-746-3357