Provider Demographics
NPI:1376558924
Name:SANDTS PHARMACY
Entity Type:Organization
Organization Name:SANDTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROBLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-863-5535
Mailing Address - Street 1:6 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEN ARGYL
Mailing Address - State:PA
Mailing Address - Zip Code:18072-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RT 209 MONROE PLAZA
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-992-4112
Practice Address - Fax:570-992-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413400L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3949267OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3949267OtherOTHER ID NUMBER-COMMERCIAL NUMBER