Provider Demographics
NPI:1760736870
Name:LECOM MTM SERVICES
Entity Type:Organization
Organization Name:LECOM MTM SERVICES
Other - Org Name:LECOM SCHOOL OF PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:814-860-8430
Mailing Address - Street 1:1858 W GRANDVIEW BLVD
Mailing Address - Street 2:ATTN.REBECCA WISE-BAYFRONT CAMPUS
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1025
Mailing Address - Country:US
Mailing Address - Phone:814-868-2584
Mailing Address - Fax:814-868-2589
Practice Address - Street 1:1858 W GRANDVIEW BLVD
Practice Address - Street 2:ATTN.REBECCA WISE-BAYFRONT CAMPUS
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1025
Practice Address - Country:US
Practice Address - Phone:814-868-2584
Practice Address - Fax:814-868-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch