Organization
COSTA DRUGS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK L CELLERARI RPH (MANAGER)
(570) 587-4717
Entity
Organization
Contact information
Practice address
100 OLD LACKAWANNA TRL, CLARKS SUMMIT, PA 18411-9108
(570) 587-4717
(570) 587-2619
Mailing address
100 OLD LACKAWANNA TRL, CLARKS SUMMIT, PA 18411-9108
(570) 587-4717
(570) 587-2619
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PP410982L
PA
3336C0003X
Community/Retail Pharmacy
PP410982L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005826490002
—
PA
01
—
0393872
PACE PROVIDER NUMBER
PA
01
—
3938721
NCPDP NUMBER
PA
Enumeration date
11/14/2006
Last updated
09/11/2025
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