1235294422 NPI number — UPMC WELLSBORO

Table of content: (NPI 1235294422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235294422 NPI number — UPMC WELLSBORO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC WELLSBORO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOLDIERS AND SAILORS MEMORIAL HOSPITAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235294422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 GRANT ST., US STEEL TOWER, 59TH FLOOR
Provider Second Line Business Mailing Address:
C/O RENEE JOHNSON
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15219-2740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-623-6303
Provider Business Mailing Address Fax Number:
412-623-6369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32-36 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-723-0157
Provider Business Practice Location Address Fax Number:
570-724-6394
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCTISH
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
570-723-0157

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X , with the licence number: HP418196L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100003767 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085544 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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