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General NPI Number Information
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NPI Number | 1255405601
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Entity Type | Organization
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Legal Business Name | JAY R MONTGOMERY
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Dates
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Enumeration Date | 11/19/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 114 N ALLEGHENY ST
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City | BELLEFONTE
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State | PA
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Zip | 16823-1627
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Country | US
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Telephone | 814-355-2914
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Fax | 814-355-7628
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Provider Business Mailing Address
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Address Line | 114 N ALLEGHENY ST
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City | BELLEFONTE
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State | PA
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Zip | 16823-1627
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Country | US
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Telephone | 814-355-2914
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Fax | 814-355-7628
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAY RONALD MONTGOMERY
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Credential | RPH.
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Telephone | 814-355-2914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP411782L
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License Number State | PA
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