Healthcare Provider Details

I. General information

NPI: 1265941181
Provider Name (Legal Business Name): SHELLEY LYNN JANOVICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CHESTNUT ST STE 200
WASHINGTON PA
15301-4631
US

IV. Provider business mailing address

234 HAWTHORN RD
CLAYSVILLE PA
15323-1027
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-7710
  • Fax: 724-223-7712
Mailing address:
  • Phone: 724-350-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041477L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: