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General NPI Number Information
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NPI Number | 1629580311
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Entity Type | Organization
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Legal Business Name | POCONO COMMUNITY PHARMACY INC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1656 ROUTE 209 UNIT 6
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7819
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Country | US
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Telephone | 570-801-7886
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Fax | 267-457-3225
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Provider Business Mailing Address
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Address Line | 1656 ROUTE 209 UNIT 6 PLEASANT VALLEY PLAZA
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7819
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Country | US
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Telephone | 570-801-7886
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Fax | 267-457-3225
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Authorized Official
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Title or Position | PRESIDENT
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Name | UMESH PATEL
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Credential |
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Telephone | 484-274-5428
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482757
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License Number State | PA
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