Healthcare Provider Details

I. General information

NPI: 1013124379
Provider Name (Legal Business Name): ANNA M WODLINGER JACKSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA M WODLINGER

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N BROAD ST
PHILADELPHIA PA
19140-5101
US

IV. Provider business mailing address

501 LANTERN LN
PHILADELPHIA PA
19128-1054
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3987
  • Fax:
Mailing address:
  • Phone: 215-508-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP045225L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: