=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720509425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA FIANT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2017
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 RITTENHOUSE RD STE 200
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-344-0450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 RITTENHOUSE RD STE 200
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-344-0450
-----------------------------------------------------
Fax | 610-431-1931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP451438
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | RP451438
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------