Provider Demographics
NPI:1275139321
Name:MISHKULA-MORGAN, JENNIFER JILL (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:MISHKULA-MORGAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1055
Mailing Address - Country:US
Mailing Address - Phone:570-587-1205
Mailing Address - Fax:570-587-4610
Practice Address - Street 1:101 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1055
Practice Address - Country:US
Practice Address - Phone:570-587-1205
Practice Address - Fax:570-587-4610
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist