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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