Provider Demographics
NPI:1801078480
Name:CCRX
Entity type:Organization
Organization Name:CCRX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJAL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-655-1911
Mailing Address - Street 1:225 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1058
Mailing Address - Country:US
Mailing Address - Phone:157-065-5191
Mailing Address - Fax:
Practice Address - Street 1:225 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1058
Practice Address - Country:US
Practice Address - Phone:157-065-5191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415505L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3975227OtherNCPDP
PA1912080656OtherNPI