Healthcare Provider Details

I. General information

NPI: 1134441942
Provider Name (Legal Business Name): JENNIFER UPHOLD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 MAPLE ST
FRIENDSVILLE MD
21531-2148
US

IV. Provider business mailing address

320 SICKLE RIDGE RD
CONFLUENCE PA
15424-2064
US

V. Phone/Fax

Practice location:
  • Phone: 301-746-5881
  • Fax: 301-746-5803
Mailing address:
  • Phone: 814-442-0341
  • Fax: 301-746-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16266
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP046241L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: