=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396765269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACPO 2 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1009 WASHINGTON BLVD
-----------------------------------------------------
City | WILLIAMSPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17701-3633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-323-7344
-----------------------------------------------------
Fax | 570-323-9285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1009 WASHINGTON BOULEVARD
-----------------------------------------------------
City | WILLIAMSPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-323-7344
-----------------------------------------------------
Fax | 570-323-9285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. WAYNE A MILLER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 570-323-7344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP412323L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------