Provider Demographics
NPI:1568762623
Name:DAVIES, JILL ALYSSA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ALYSSA
Last Name:DAVIES
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 1:167 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9707
Mailing Address - Country:US
Mailing Address - Phone:215-997-0758
Mailing Address - Fax:
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2832
Practice Address - Country:US
Practice Address - Phone:215-699-7555
Practice Address - Fax:215-699-6792
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042102R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist