Provider Demographics
NPI:1508862715
Name:APS PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:APS PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MGR/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEGRABA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-655-1911
Mailing Address - Street 1:225 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1058
Mailing Address - Country:US
Mailing Address - Phone:570-655-1911
Mailing Address - Fax:570-655-1472
Practice Address - Street 1:225 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1058
Practice Address - Country:US
Practice Address - Phone:570-655-1911
Practice Address - Fax:570-655-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415505L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007507920003Medicaid
PA3975527OtherNABP
PA4451430001Medicare ID - Type Unspecified