Provider Demographics
NPI:1255328779
Name:EBERLY, JEANNE M (RPH)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:EBERLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FIELDCREST LN
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2916
Mailing Address - Country:US
Mailing Address - Phone:717-940-0735
Mailing Address - Fax:
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2701
Practice Address - Country:US
Practice Address - Phone:717-733-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032090L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist