Provider Demographics
NPI:1427583509
Name:LIGOTSKI, JOSEPH JR
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LIGOTSKI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1216
Mailing Address - Country:US
Mailing Address - Phone:570-991-1763
Mailing Address - Fax:
Practice Address - Street 1:110 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1216
Practice Address - Country:US
Practice Address - Phone:570-991-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-033628-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist