Provider Demographics
NPI:1023268323
Name:PA DEPTMENT OF PUBLIC WELFARE
Entity type:Organization
Organization Name:PA DEPTMENT OF PUBLIC WELFARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-705-2774
Mailing Address - Street 1:1451 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9504
Mailing Address - Country:US
Mailing Address - Phone:570-319-3520
Mailing Address - Fax:570-319-3510
Practice Address - Street 1:1451 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9504
Practice Address - Country:US
Practice Address - Phone:570-319-3520
Practice Address - Fax:570-319-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818173336L0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP481817OtherPA PHARMACY PERMIT NUMBER