Provider Demographics
NPI:1285639492
Name:WASCHKOS PHARMACY INC
Entity Type:Organization
Organization Name:WASCHKOS PHARMACY INC
Other - Org Name:WASCHKOS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:570-454-2951
Mailing Address - Street 1:257 N WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5563
Mailing Address - Country:US
Mailing Address - Phone:570-454-2951
Mailing Address - Fax:570-454-2951
Practice Address - Street 1:257 N WYOMING ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5563
Practice Address - Country:US
Practice Address - Phone:570-454-2951
Practice Address - Fax:570-454-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412827L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005847880001Medicaid
3918200Medicare UPIN
PA0005847880001Medicaid