Provider Demographics
NPI:1275187106
Name:THREATT, JOCELYN CORIN (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:CORIN
Last Name:THREATT
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BAILEYS CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1398
Mailing Address - Country:US
Mailing Address - Phone:240-603-2079
Mailing Address - Fax:
Practice Address - Street 1:10 E WILSON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7331
Practice Address - Country:US
Practice Address - Phone:301-790-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist