MEDICARE: JEAN MARIE QUATRA 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	RP032967L	PA

General Provider Information

NPI Number	:	1366911182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MARIE QUATRA RPH

Provider Business Mailing Address
First Line	:	1206 DIMMICK ST
Second Line	:
City	:	DICKSON CITY
State	:	PA
Zip	:	18519-1224
Country	:	US
Telephone Number	:	570-383-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 NORTHERN BLVD
Second Line	:
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-2220
Country	:	US
Telephone Number	:	570-587-2460
Fax Number	:

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

Provider Enumeration Date	:	11/21/2018
Last Update Date	:	11/21/2018

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