Organization
THE VACCINE SHOPPE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMI LYNN KRISTIN PANEK RPH (MANAGER)
(570) 762-9132
Entity
Organization
Contact information
Practice address
205 BUTLER STREET, PITTSTON, PA 18640
(570) 762-9132
Mailing address
200 YORK AVE, WEST PITTSTON, PA 18643-2435
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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