Provider Demographics
NPI:1457370165
Name:SELVOCKI, MARK FRANK (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANK
Last Name:SELVOCKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HOMETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4033
Mailing Address - Country:US
Mailing Address - Phone:570-668-5655
Mailing Address - Fax:
Practice Address - Street 1:7 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1707
Practice Address - Country:US
Practice Address - Phone:570-695-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030247L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist