Healthcare Provider Details

I. General information

NPI: 1386553089
Provider Name (Legal Business Name): JESSICA LUNSFORD CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 BUCKAROO LN
BELLEFONTE PA
16823-9119
US

IV. Provider business mailing address

1809 AARON DR
LOCK HAVEN PA
17745-9213
US

V. Phone/Fax

Practice location:
  • Phone: 814-355-2429
  • Fax:
Mailing address:
  • Phone: 570-502-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPTE010733
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: