Healthcare Provider Details

I. General information

NPI: 1831102086
Provider Name (Legal Business Name): JEFFREYS DRUG STORE LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE STE 1
CANONSBURG PA
15317-1301
US

IV. Provider business mailing address

1 N CENTRAL AVE STE 1
CANONSBURG PA
15317-1301
US

V. Phone/Fax

Practice location:
  • Phone: 724-745-6078
  • Fax: 724-745-8818
Mailing address:
  • Phone: 724-745-6078
  • Fax: 724-745-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP481350
License Number StatePA

VIII. Authorized Official

Name: MRS. GERMAINE ANN ZUBRITSKY
Title or Position: PHARMACIST
Credential: RPH
Phone: 724-745-6078