MEDICARE: ROBERT WALTER PIAVIS JR. 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	RP034230L	PA

General Provider Information

NPI Number	:	1245742972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WALTER PIAVIS JR. RPH

Provider Business Mailing Address
First Line	:	110 LILY LAKE RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-8833
Country	:	US
Telephone Number	:	570-574-7258
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LILY LAKE RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-8833
Country	:	US
Telephone Number	:	570-574-7258
Fax Number	:

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

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	06/16/2018

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