Healthcare Provider Details

I. General information

NPI: 1295402378
Provider Name (Legal Business Name): JANINE TUBBS SANNER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0001
US

IV. Provider business mailing address

201 STATE ST
ERIE PA
16550-0001
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2488
  • Fax:
Mailing address:
  • Phone: 814-877-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP039767L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: