Provider Demographics
NPI:1750413928
Name:VIERCINSKI, ROBERT JOHN
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:VIERCINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2804
Mailing Address - Country:US
Mailing Address - Phone:570-586-1961
Mailing Address - Fax:570-587-0319
Practice Address - Street 1:100 E GROVE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1774
Practice Address - Country:US
Practice Address - Phone:570-586-1961
Practice Address - Fax:570-587-0319
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030304L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist