Healthcare Provider Details

I. General information

NPI: 1144672890
Provider Name (Legal Business Name): JESSICA ANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

5139 EMPIRE DR
BRIDGEVILLE PA
15017-1589
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-0223
  • Fax:
Mailing address:
  • Phone: 864-561-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP449790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: