Provider Demographics
NPI:1356813992
Name:PANTHER CREEK PHARMACY LLC
Entity Type:Organization
Organization Name:PANTHER CREEK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-273-5311
Mailing Address - Street 1:74 W CATAWISSA ST
Mailing Address - Street 2:
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1509
Mailing Address - Country:US
Mailing Address - Phone:570-273-5311
Mailing Address - Fax:570-273-5322
Practice Address - Street 1:74 W CATAWISSA ST
Practice Address - Street 2:
Practice Address - City:NESQUEHONING
Practice Address - State:PA
Practice Address - Zip Code:18240-1509
Practice Address - Country:US
Practice Address - Phone:570-273-5311
Practice Address - Fax:570-273-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841793569OtherCMS NPPES