NPIMap

Organization Active NPI

Bloss Pharmacy, Inc.

Doing business as Bloss Pharmacy

  • Community/Retail Pharmacy
  • Blossburg, PA
National Provider Identifier
1083619415
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP411873L Issued in PA
Legal business name
BLOSS PHARMACY, INC.
Doing business as
Bloss Pharmacy
Practice address
2 Riverside Plaza
Blossburg, PA 16912-1137
Phone
(570) 638-2820
Fax
(570) 638-3642
NPI assigned
Jun 13, 2005
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer McTish, PHARMD
Title
Owner
Phone
(570) 638-2820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PP411873L PA Primary

Addresses

Primary practice location

2 Riverside Plaza
Blossburg, PA 16912-1137

Mailing address

2 Riverside Plaza
Blossburg, PA 16912-1137
Phone (570) 638-2820

Other identifiers 2

IdentifierTypeStateIssuer
102574237MedicaidPA
2128878OtherPK

Other names 1

  • Bloss Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

2 Riverside Plz
Blossburg, PA 16912
Phone (570) 638-2820

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1083619415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 RIVERSIDE PLAZA",
            "city": "BLOSSBURG",
            "state": "PA",
            "postal_code": "169121137",
            "telephone_number": "570-638-2820",
            "fax_number": "570-638-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 RIVERSIDE PLAZA",
            "city": "BLOSSBURG",
            "state": "PA",
            "postal_code": "169121137",
            "telephone_number": "570-638-2820",
            "fax_number": "570-638-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSS PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "MCTISH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-638-2820",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP411873L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102574237",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2128878",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloss Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloss Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blossburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.