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General NPI Number Information
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NPI Number | 1093315921
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Entity Type | Individual
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Provider Name | BERNARD KLEMCHAK
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 100 LUNGER DR
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City | BLOOMSBURG
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State | PA
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Zip | 17815-8330
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Country | US
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Telephone | 570-389-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 2016 W MOUNTAIN LAKE DR
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City | BEAR CREEK TOWNSHIP
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State | PA
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Zip | 18702-8286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP450422
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License Number State | PA
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