Provider Demographics
NPI:1013396167
Name:PASTOREK, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PASTOREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1369
Mailing Address - Country:US
Mailing Address - Phone:724-459-7400
Mailing Address - Fax:
Practice Address - Street 1:135 E MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717
Practice Address - Country:US
Practice Address - Phone:724-459-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist