Healthcare Provider Details

I. General information

NPI: 1457172827
Provider Name (Legal Business Name): JESSICA FAYE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SCALP AVE
JOHNSTOWN PA
15904-3308
US

IV. Provider business mailing address

539 SHAULIS RD
HOLLSOPPLE PA
15935-6632
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-9631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458892
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: