Provider Demographics
NPI:1255654059
Name:ABBOTT, JESSICA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 TRA MAR COVE LN
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 TRA MAR COVE LN
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4121
Practice Address - Country:US
Practice Address - Phone:610-844-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist