Organization
SRURA PHARMACY LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAIMIN PATEL (MANAGER)
(706) 331-5959
Entity
Organization
Contact information
Practice address
69 N MARKET ST, NANTICOKE, PA 18634-1553
(570) 735-2300
(570) 258-2036
Mailing address
69 N MARKET ST, NANTICOKE, PA 18634-1553
(570) 735-2300
(570) 258-2036
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP412356L
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029143750001
—
PA
01
—
2145152
PK
—
Enumeration date
12/18/2013
Last updated
11/07/2016
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