Provider Demographics
NPI:1871881573
Name:ETHICAL FACTOR RX LLC
Entity type:Organization
Organization Name:ETHICAL FACTOR RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOMCYKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-606-3622
Mailing Address - Street 1:PO BOX 4047
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-6047
Mailing Address - Country:US
Mailing Address - Phone:570-606-3622
Mailing Address - Fax:570-371-6317
Practice Address - Street 1:4213 BIRNEY AVE STE 4
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-9523
Practice Address - Country:US
Practice Address - Phone:570-606-3622
Practice Address - Fax:570-371-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009850332B00000X
NJ28RO00071900333600000X
MDP062703336C0003X
PAPP4821913336H0001X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871881573Medicaid
NY03629343Medicaid
MI1871881573Medicaid
PA102678278 0002Medicaid
MD4222598 00Medicaid
NC1871881573Medicaid
OH1871881573Medicaid
2131101OtherPK
NJ0298883Medicaid
AZ1871881573Medicaid
OK200595730AMedicaid