MEDICARE: PAUL DOMINICK ROCZNIAK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP035465L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP035465L	OTHER	PA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1033111604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DOMINICK ROCZNIAK RPH

Provider Business Mailing Address
First Line	:	102 SEKOL AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18504-1035
Country	:	US
Telephone Number	:	570-344-3621
Fax Number	:	408-869-1760

Provider Business Practice Location Address
First Line	:	1011 SCRANTON CARBONDALE HWY
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1127
Country	:	US
Telephone Number	:	570-489-4274
Fax Number	:	570-489-1834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/30/2007

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