Provider Demographics
NPI:1750422424
Name:DEGUTIS PHARMACY INC
Entity type:Organization
Organization Name:DEGUTIS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-544-2264
Mailing Address - Street 1:245 SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1345
Mailing Address - Country:US
Mailing Address - Phone:570-544-2264
Mailing Address - Fax:
Practice Address - Street 1:245 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1345
Practice Address - Country:US
Practice Address - Phone:570-544-2264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410565L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3919959OtherNABP