Provider Demographics
NPI:1184601312
Name:TABLETT INC
Entity type:Organization
Organization Name:TABLETT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-648-5242
Mailing Address - Street 1:605 N SHAMOKIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872
Mailing Address - Country:US
Mailing Address - Phone:570-648-5242
Mailing Address - Fax:570-648-3606
Practice Address - Street 1:605 N SHAMOKIN ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872
Practice Address - Country:US
Practice Address - Phone:570-648-5242
Practice Address - Fax:570-648-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414448L333600000X
PA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3962378OtherNCPDP #
PA0012368040001Medicaid
PA0012368040001Medicaid
PA0970110001Medicare NSC