MEDICARE: JUDITH ZOCK CASEY R PH

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	RP029958L	PA

General Provider Information

NPI Number	:	1720129299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ZOCK CASEY R PH

Provider Business Mailing Address
First Line	:	174 APPLE DR
Second Line	:
City	:	CRESSON
State	:	PA
Zip	:	16630-1654
Country	:	US
Telephone Number	:	814-886-8825
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 MAIN ST
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-1539
Country	:	US
Telephone Number	:	814-736-4530
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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