Provider Demographics
NPI:1629591748
Name:STAFANOSKI, THOMAS CHARLES
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:STAFANOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1330
Mailing Address - Country:US
Mailing Address - Phone:570-343-7883
Mailing Address - Fax:570-343-7886
Practice Address - Street 1:4113 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1330
Practice Address - Country:US
Practice Address - Phone:570-343-7883
Practice Address - Fax:570-343-7886
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034284L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist