Provider Demographics
NPI:1154477503
Name:STRUTT, JEFFRY F (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:F
Last Name:STRUTT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SIMPSON HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2528
Mailing Address - Country:US
Mailing Address - Phone:412-751-6100
Mailing Address - Fax:
Practice Address - Street 1:108 SIMPSON HOWELL RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2528
Practice Address - Country:US
Practice Address - Phone:412-751-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032541L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010509470000Medicaid
PA0728010001Medicare NSC