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Organization
PA DEPTMENT OF PUBLIC WELFARE
Active
Organization
PA DEPTMENT OF PUBLIC WELFARE
Active
Other names
Clarks Summit State Hospital Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI A. EISNER (ADMINISTRATOR)
(717) 705-2774
Entity
Organization
Contact information
Practice address
1451 HILLSIDE DR, CLARKS SUMMIT, PA 18411-9504
(570) 319-3520
(570) 319-3510
Mailing address
1451 HILLSIDE DR, CLARKS SUMMIT, PA 18411-9504
(570) 319-3520
(570) 319-3510
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PP481817
PA
3336L0003X
Long Term Care Pharmacy
PP481817
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PP481817
PA PHARMACY PERMIT NUMBER
PA
Enumeration date
09/23/2008
Last updated
03/19/2018
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