1770657223 NPI number — SARA A WASCOVICH RPH

Table of content: SARA A WASCOVICH RPH (NPI 1770657223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770657223 NPI number — SARA A WASCOVICH RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASCOVICH
Provider First Name:
SARA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1770657223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 4 BOX 4371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18444-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-346-8064
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18505-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-1168
Provider Business Practice Location Address Fax Number:
570-207-4633
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP028915L , 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: RP028915L . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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