Healthcare Provider Details

I. General information

NPI: 1750781498
Provider Name (Legal Business Name): JESSICA LAUREN RAFTER PHARMD., RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2014
Last Update Date: 05/07/2021
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 NEW YORK 12
ALEXANDRIA BAY NY
13607
US

IV. Provider business mailing address

40 STATE HIGHWAY 310
CANTON NY
13617-1459
US

V. Phone/Fax

Practice location:
  • Phone: 315-482-6270
  • Fax: 315-482-4692
Mailing address:
  • Phone: 315-386-4563
  • Fax: 315-386-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: