Jerome Prusack
Individual provider Active NPI Pharmacist · Springville, PA
NPI 1225577463 · NPPES record last updated Feb 21, 2017
Key facts
- NPI
- 1225577463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP000136L (PA)
- Practice address
- 6591 State Route 29
Springville, PA 18844-7608 - Phone
- (570) 737-7004
- NPI assigned
- Feb 21, 2017
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP000136L | PA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP000136L | PA | Yes |
Addresses
Primary practice location
6591 State Route 29
Springville, PA 18844-7608
Mailing address
6591 State Route 29
Springville, PA 18844-7608
Other providers in Springville, PA
All providers in Springville, PA · Pharmacist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2017. 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.