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Organization

HUSAK HOLDINGS JTL, INC

Active
Other names
The Medicine Shoppe
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LISA H POPKO R.PH. (PRESIDENT)
(570) 759-1239
Entity
Organization

Contact information

Practice address
145 E 9TH ST, BERWICK, PA 18603-3132
(570) 759-1239
(570) 759-1230
Mailing address
145 E 9TH ST, BERWICK, PA 18603-3132
(570) 759-1239
(570) 759-1230

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP410850L
PA
3336C0002X
Clinic Pharmacy
RPI000634
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP410850L
PA
335E00000X
Prosthetic/Orthotic Supplier
PP4108501
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0073970160002
PA
01
3937767
NCPDP #
PA
Enumeration date
02/22/2006
Last updated
03/07/2023
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