Stephen Brosky, RPH
Individual provider Active NPI Pharmacist · Old Forge, PA
NPI 1104149434 · NPPES record last updated Mar 1, 2010
Key facts
- NPI
- 1104149434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP040035L (PA)
- Practice address
- 213 Amity Ave
Old Forge, PA 18518-1034 - Phone
- (570) 821-6190
- Fax
- (570) 821-6192
- NPI assigned
- Mar 1, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP040035L | PA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP040035L | PA | Yes |
Addresses
Primary practice location
213 Amity Ave
Old Forge, PA 18518-1034
Mailing address
213 Amity Ave
Old Forge, PA 18518-1034
Phone (570) 821-6190
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RP040035L | Other | PA | STATE LICENSE RP-040035L |
Other providers in Old Forge, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.