=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013365592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE ANN WASKO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2016
-----------------------------------------------------
Last Update Date | 05/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 HULST DRIVE STE 722
-----------------------------------------------------
City | MATAMORAS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-491-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 ALTA VISTA TER
-----------------------------------------------------
City | PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18640-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-540-6541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP030754L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------