Provider Demographics
NPI:1417513292
Name:SUPERIOR CARE PHARMACY INC
Entity Type:Organization
Organization Name:SUPERIOR CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CDE
Authorized Official - Phone:570-383-6700
Mailing Address - Street 1:518 BURKE BYP
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1805
Mailing Address - Country:US
Mailing Address - Phone:570-383-6700
Mailing Address - Fax:570-383-9700
Practice Address - Street 1:518 BURKE BYP
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1805
Practice Address - Country:US
Practice Address - Phone:570-383-6700
Practice Address - Fax:570-383-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERIOR CARE PHARMACY INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011414540001Medicaid