Provider Demographics
NPI:1104829373
Name:UPTOWN PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:UPTOWN PHARMACY INCORPORATED
Other - Org Name:UPTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:RADZAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-339-4953
Mailing Address - Street 1:200 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2148
Mailing Address - Country:US
Mailing Address - Phone:570-339-4953
Mailing Address - Fax:570-339-4290
Practice Address - Street 1:200 S OAK ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2148
Practice Address - Country:US
Practice Address - Phone:570-339-4953
Practice Address - Fax:570-339-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410579L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1045520001Medicare ID - Type Unspecified
PA000559776000124Medicare ID - Type Unspecified