MEDICARE: MRS. JACQUELINE JANE STANTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1770231375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE JANE STANTON

Provider Business Mailing Address
First Line	:	910 W BROADWAY
Second Line	:
City	:	RED LION
State	:	PA
Zip	:	17356-1952
Country	:	US
Telephone Number	:	717-244-2919
Fax Number	:	717-244-2821

Provider Business Practice Location Address
First Line	:	910 W BROADWAY
Second Line	:
City	:	RED LION
State	:	PA
Zip	:	17356-1952
Country	:	US
Telephone Number	:	717-244-2919
Fax Number	:	717-244-2821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2022
Last Update Date	:	03/13/2022

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Directions to “ MRS. JACQUELINE JANE STANTON ” Practice Location

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