Provider Demographics
NPI:1437451960
Name:DERRICK, JUDITH J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:J
Last Name:DERRICK
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 1:7795 CHASE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16134
Mailing Address - Country:US
Mailing Address - Phone:724-588-3216
Mailing Address - Fax:724-662-1904
Practice Address - Street 1:315 S ERIE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1555
Practice Address - Country:US
Practice Address - Phone:724-662-2240
Practice Address - Fax:724-662-1904
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033918L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI000694OtherIMMUNIZING PHARMACIST
PARP033918LOtherPHARMACY LICENCE