Healthcare Provider Details

I. General information

NPI: 1922684687
Provider Name (Legal Business Name): JENA MOYER CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 FRUITVILLE PIKE STE A
LANCASTER PA
17601-4098
US

IV. Provider business mailing address

1700 FRUITVILLE PIKE STE A
LANCASTER PA
17601-4098
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8161
  • Fax: 717-397-8192
Mailing address:
  • Phone: 717-397-8161
  • Fax: 717-397-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: