Healthcare Provider Details

I. General information

NPI: 1831102912
Provider Name (Legal Business Name): JEFFREYS DRUG STORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

IV. Provider business mailing address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

V. Phone/Fax

Practice location:
  • Phone: 724-745-6480
  • Fax: 724-745-8818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP411156L
License Number StatePA

VIII. Authorized Official

Name: GERARD OHARE
Title or Position: OWNER
Credential:
Phone: 724-745-6480