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NPI Code Detail

MEDICARE: CCRX

MEDICARE: CCRX
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
13336L0003XLong Term Care PharmacyPP415505LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13975227OTHERPANCPDP
21912080656OTHERPANPI

General Provider Information

NPI Number : 1801078480
Entity Type Code : Organization
Provider Name (Legal Business Name) : CCRX
Provider Business Mailing Address
First Line : 225 OVERLOOK DR
Second Line :
City : PITTSTON
State : PA
Zip : 18640-1058
Country : US
Telephone Number : 157-065-5191
Fax Number :
Provider Business Practice Location Address
First Line : 225 OVERLOOK DR
Second Line :
City : PITTSTON
State : PA
Zip : 18640-1058
Country : US
Telephone Number : 157-065-5191
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : DR. SAJAL KUMAR ROY
Credential : PHARMD
Telephone Number : 570-655-1911
Provider Enumeration Date : 12/05/2007
Last Update Date : 12/05/2007

Similar Medicare Providers

1508862715 — APS PHARMACY SERVICES, INC.
Practice Location Address:
225 OVERLOOK DR
PITTSTON, PA
18640-1058
Practice Phone: 570-655-1911
Practice Fax: 570-655-1472
1649450081 — MRS. EILEEN T TOUSSAINT RPH
Practice Location Address:
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PITTSTON, PA
18640-1058
Practice Phone: 800-655-1471
Practice Fax:
1326220724 — MR. JOSEPH THOMAS DEGRABA JR. RPH
Practice Location Address:
225 OVERLOOK DR
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18640-1058
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Practice Fax:
1952585671 — DR. LISA F TOMCYKOSKI PHARMD
Practice Location Address:
225 OVERLOOK DR
PITTSTON, PA
18640-1058
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Practice Fax: 570-655-1472
1144406125 — MRS. RENEE R BENDETTO RPH
Practice Location Address:
225 OVERLOOK DR
PITTSTON, PA
18640-1058
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Practice Fax: 570-655-1472
1649457433 — DR. SUSAN ANN NICHOLE KAUSMEYER PHARMD
Practice Location Address:
225 OVERLOOK DR
PITTSTON, PA
18640-1058
Practice Phone: 570-655-1911
Practice Fax: 570-655-1472

Directions to “CCRX ” Practice Location

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