MEDICARE: MR. JEFFREY LEE PACKECH R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP032456L	PA

General Provider Information

NPI Number	:	1104936590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LEE PACKECH R.PH.

Provider Business Mailing Address
First Line	:	420 E END MOUNTAIN RD
Second Line	:
City	:	MILL HALL
State	:	PA
Zip	:	17751-9449
Country	:	US
Telephone Number	:	570-726-6008
Fax Number	:	570-748-7390

Provider Business Practice Location Address
First Line	:	127 E CHURCH ST
Second Line	:
City	:	LOCK HAVEN
State	:	PA
Zip	:	17745-2007
Country	:	US
Telephone Number	:	570-748-5209
Fax Number	:	570-748-7390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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