Provider Demographics
NPI:1366044406
Name:GARBER, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:GARBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 RUGBY DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8533
Mailing Address - Country:US
Mailing Address - Phone:215-208-5757
Mailing Address - Fax:
Practice Address - Street 1:168 N FLOWERS MILL RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1652
Practice Address - Country:US
Practice Address - Phone:215-208-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028972L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist