Healthcare Provider Details

I. General information

NPI: 1508853623
Provider Name (Legal Business Name): JENNIFER L VAIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PENNY LN
JEANNETTE PA
15644-4304
US

IV. Provider business mailing address

134 TERRY ST
DELMONT PA
15626-1122
US

V. Phone/Fax

Practice location:
  • Phone: 724-744-1901
  • Fax: 724-744-1908
Mailing address:
  • Phone: 724-468-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: