Provider Demographics
NPI:1164992707
Name:SERRATORE, PAMELA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:SERRATORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644
Mailing Address - Country:US
Mailing Address - Phone:570-333-4508
Mailing Address - Fax:
Practice Address - Street 1:1 WEIS PLAZA
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-735-3979
Practice Address - Fax:570-735-4567
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034682L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist