Provider Demographics
NPI:1548230105
Name:TICE, SALLY ANN (PHARMD, MHA)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ANN
Last Name:TICE
Suffix:
Gender:F
Credentials:PHARMD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 STEIN RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-9240
Mailing Address - Country:US
Mailing Address - Phone:570-875-2681
Mailing Address - Fax:
Practice Address - Street 1:GEISINGER MEDICAL CENTER PHARMACY DEPT 42-01
Practice Address - Street 2:100 N ACADEMY AVE
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-0001
Practice Address - Country:US
Practice Address - Phone:570-271-6691
Practice Address - Fax:570-271-7278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035523L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy