Provider Demographics
NPI:1538146444
Name:OLCESE, JANICE E (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:E
Last Name:OLCESE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5716
Mailing Address - Country:US
Mailing Address - Phone:570-648-4876
Mailing Address - Fax:
Practice Address - Street 1:400 W SPRUCE ST
Practice Address - Street 2:TOM OLCESE PHARMACY
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5716
Practice Address - Country:US
Practice Address - Phone:570-648-7891
Practice Address - Fax:570-648-2007
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035719L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015542460002Medicaid
PA0015542460003OtherMEDICAID CROSSOVER FOR ME
PA0015542460002Medicaid