# PA DEPTMENT OF PUBLIC WELFARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clarks Summit State Hospital Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023268323
- **Authorized official:** PATTI A. EISNER (ADMINISTRATOR)
- **Authorized official phone:** (717) 705-2774

## Contact information

- **Practice address:** 1451 HILLSIDE DR, CLARKS SUMMIT, PA 18411-9504
- **Practice address phone:** (570) 319-3520
- **Practice address fax:** (570) 319-3510
- **Mailing address:** 1451 HILLSIDE DR, CLARKS SUMMIT, PA 18411-9504
- **Mailing address phone:** (570) 319-3520
- **Mailing address fax:** (570) 319-3510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | PP481817 | PA | Yes |
| 3336L0003X | Long Term Care Pharmacy | PP481817 | PA | — |

## Other

- **Enumeration date:** 09/23/2008
- **Last updated:** 03/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PP481817 | PA PHARMACY PERMIT NUMBER | PA |