Healthcare Provider Details

I. General information

NPI: 1336508761
Provider Name (Legal Business Name): JENNIFER PEPPER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SULLIVAN ST
CANTON PA
17724-1733
US

IV. Provider business mailing address

121 SULLIVAN ST
CANTON PA
17724-1733
US

V. Phone/Fax

Practice location:
  • Phone: 570-673-4372
  • Fax: 570-673-7247
Mailing address:
  • Phone: 570-673-4372
  • Fax: 570-673-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP437781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: