Provider Demographics
NPI:1578882270
Name:MOTSKO, RENEE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:MOTSKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GOLD STAR PLZ
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-2530
Mailing Address - Country:US
Mailing Address - Phone:570-462-9651
Mailing Address - Fax:570-462-3256
Practice Address - Street 1:1 GOLD STAR PLZ
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-2530
Practice Address - Country:US
Practice Address - Phone:570-462-9651
Practice Address - Fax:570-462-3272
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036519L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist