Provider Demographics
NPI:1962400226
Name:SKALLA, GARY
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:SKALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1137
Mailing Address - Country:US
Mailing Address - Phone:570-208-0277
Mailing Address - Fax:
Practice Address - Street 1:220 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1137
Practice Address - Country:US
Practice Address - Phone:570-208-0277
Practice Address - Fax:570-208-7201
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045156L183500000X
KY017532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist