Provider Demographics
NPI:1770657223
Name:WASCOVICH, SARA A (RPH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:WASCOVICH
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:RR 4 BOX 4371
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9278
Mailing Address - Country:US
Mailing Address - Phone:570-346-8064
Mailing Address - Fax:
Practice Address - Street 1:609 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1813
Practice Address - Country:US
Practice Address - Phone:570-961-1168
Practice Address - Fax:570-207-4633
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028915L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028915LOtherSTATE LICENSE NUMBER