=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316131881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSQUEHANNA HEALTH PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 HIGH ST
-----------------------------------------------------
City | WILLIAMSPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17701-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-321-2818
-----------------------------------------------------
Fax | 570-321-2819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 642464
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15264-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-328-4788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ROGER C YOST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-321-3175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------