Provider Demographics
NPI:1619296969
Name:TROYANO, JESSICA LARA (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LARA
Last Name:TROYANO
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 1:3145 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-9300
Mailing Address - Country:US
Mailing Address - Phone:610-286-0920
Mailing Address - Fax:610-286-0960
Practice Address - Street 1:3145 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-9300
Practice Address - Country:US
Practice Address - Phone:610-286-0920
Practice Address - Fax:610-286-0960
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP437139OtherPHARMACY LICENSE