Provider Demographics
NPI:1629580311
Name:POCONO COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:POCONO COMMUNITY PHARMACY INC
Other - Org Name:POCONO COMMUNITY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-274-5428
Mailing Address - Street 1:1656 ROUTE 209 UNIT 6
Mailing Address - Street 2:PLEASANT VALLEY PLAZA
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7819
Mailing Address - Country:US
Mailing Address - Phone:570-801-7886
Mailing Address - Fax:267-457-3225
Practice Address - Street 1:1656 ROUTE 209 UNIT 6
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7819
Practice Address - Country:US
Practice Address - Phone:570-801-7886
Practice Address - Fax:267-457-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172263OtherPK