Provider Demographics
NPI:1306297593
Name:RUPP, CAROLYN ANN (RPH)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:RUPP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 ORAM ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-1523
Mailing Address - Country:US
Mailing Address - Phone:570-906-4123
Mailing Address - Fax:
Practice Address - Street 1:143 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-1415
Practice Address - Country:US
Practice Address - Phone:570-562-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037653L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist