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General NPI Number Information
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NPI Number | 1770469728
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Entity Type | Individual
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Provider Name | JOHNATAN GIDEON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 420 S 5TH AVE
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City | WEST READING
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State | PA
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Zip | 19611-2143
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Country | US
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Telephone | 484-628-7426
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Fax |
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Provider Business Mailing Address
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Address Line | 14 PHILADELPHIA AVE APT 214
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City | SHILLINGTON
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State | PA
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Zip | 19607-2757
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Country | US
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Telephone | 718-926-9989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP459554
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License Number State | PA
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