Provider Demographics
NPI:1669188587
Name:PRESCRIPTION CENTER- SOUTH WASHINGTON INC
Entity type:Organization
Organization Name:PRESCRIPTION CENTER- SOUTH WASHINGTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-209-9900
Mailing Address - Street 1:329 CHERRY ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1505
Mailing Address - Country:US
Mailing Address - Phone:570-209-9900
Mailing Address - Fax:570-209-9900
Practice Address - Street 1:329 CHERRY ST STE 1A
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1505
Practice Address - Country:US
Practice Address - Phone:570-209-9900
Practice Address - Fax:570-880-7043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESCRIPTION CENTER-SOUTH WASHINGTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038775610001Medicaid