Provider Demographics
NPI:1336200187
Name:RURAL HEALTH CORP PHARMACY
Entity Type:Organization
Organization Name:RURAL HEALTH CORP PHARMACY
Other - Org Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:570-825-8741
Mailing Address - Street 1:2888 SR 28 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONROE TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18636
Mailing Address - Country:US
Mailing Address - Phone:570-298-2121
Mailing Address - Fax:
Practice Address - Street 1:2888 SR 29 S
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROE TWP
Practice Address - State:PA
Practice Address - Zip Code:18636
Practice Address - Country:US
Practice Address - Phone:570-298-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410885L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3943873OtherNABP NUMBER