MEDICARE: MR. PATRICK JOHN BOHAN 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	1835P1200X	Pharmacotherapy Pharmacist	RP033484L	PA

General Provider Information

NPI Number	:	1346486701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK JOHN BOHAN RPH

Provider Business Mailing Address
First Line	:	1000 EAST MOUNTAIN DRIVE
Second Line	:	1000 EAST MOUNTAIN DRIVE
City	:	WILKES-BARRE
State	:	PA
Zip	:	18702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E MOUNTAIN DR
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7909
Country	:	US
Telephone Number	:	570-826-7708
Fax Number	:

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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