Provider Demographics
NPI:1447772868
Name:LEHIGH VALLEY PHARMACY SERVICES-POCONO
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHARMACY SERVICES-POCONO
Other - Org Name:HEALTH SPECTRUM PHARMACY SERVICES POCONO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-369-7032
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:272-762-6337
Mailing Address - Fax:570-476-3645
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:272-762-6337
Practice Address - Fax:570-476-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170034OtherPK