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General NPI Number Information
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NPI Number | 1629059225
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Entity Type | Organization
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Legal Business Name | SPOTANSKIS PHARMACY INC
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 243 S PROSPECT ST
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City | NANTICOKE
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State | PA
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Zip | 18634-2443
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Country | US
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Telephone | 570-735-2300
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Fax | 570-735-2300
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Provider Business Mailing Address
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Address Line | 243 S PROSPECT ST
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City | NANTICOKE
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State | PA
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Zip | 18634-2443
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Country | US
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Telephone | 570-735-2300
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Fax | 570-735-2300
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH A EDMUNLOWEZ
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Credential | PHARMACIST
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Telephone | 570-735-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP412356L
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License Number State | PA
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