Healthcare Provider Details

I. General information

NPI: 1619296969
Provider Name (Legal Business Name): JESSICA LARA TROYANO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 MAIN STREET
MORGANTOWN PA
19543-9300
US

IV. Provider business mailing address

3145 MAIN STREET
MORGANTOWN PA
19543-9300
US

V. Phone/Fax

Practice location:
  • Phone: 610-286-0920
  • Fax: 610-286-0960
Mailing address:
  • Phone: 610-286-0920
  • Fax: 610-286-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP437139
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: