Organization
FAMILY PHARMACY OF JESSUP INC
Active
Other names
FAMILY PHARMACY OF JESSUP INC
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS DOUGHERTY RPH (PRESIDENT)
(570) 499-1900
Entity
Organization
Contact information
Practice address
128 CONSTITUTION AVE, JESSUP, PA 18434-1218
(570) 383-7311
(570) 383-7399
Mailing address
128 CONSTITUTION AVE, JESSUP, PA 18434-1218
(570) 383-7311
(570) 383-7399
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481064
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01863724
—
PA
01
—
3979638
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/12/2006
Last updated
09/12/2012
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