Healthcare Provider Details

I. General information

NPI: 1063734184
Provider Name (Legal Business Name): JESSICA M JAROSZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 UPPER GLEN ST
QUEENSBURY NY
12804-2019
US

IV. Provider business mailing address

724 UPPER GLEN ST
QUEENSBURY NY
12804-2019
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-3132
  • Fax:
Mailing address:
  • Phone: 518-793-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: