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General NPI Number Information
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NPI Number | 1528589694
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Entity Type | Individual
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Provider Name | LISA MAZONKEY RPH
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 58 PUBLIC SQ # 60
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City | WILKES BARRE
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State | PA
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Zip | 18701-2610
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Country | US
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Telephone | 570-284-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 105 MAIN RD
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City | SHICKSHINNY
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State | PA
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Zip | 18655-4103
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Country | US
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Telephone | 570-855-6349
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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 | RP038009L
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License Number State | PA
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