Provider Demographics
NPI:1346568839
Name:SIMONETTI, JENNIFER A (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SIMONETTI
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 1:500 PINE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1683
Mailing Address - Country:US
Mailing Address - Phone:412-771-6366
Mailing Address - Fax:412-771-9374
Practice Address - Street 1:500 PINE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1683
Practice Address - Country:US
Practice Address - Phone:412-771-6366
Practice Address - Fax:412-771-9374
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034745L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist