MEDICARE: MS. ADELE MARIE DOUGHERTY

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	183700000X	Pharmacy Technician	PTE013180	PA

General Provider Information

NPI Number	:	1902732704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADELE MARIE DOUGHERTY

Provider Business Mailing Address
First Line	:	13 COLONIAL DR
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 COLONIAL DR
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-2307
Country	:	US
Telephone Number	:	570-550-2123
Fax Number	:

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

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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