Provider Demographics
NPI:1679774863
Name:KRABAK, JILL (PHARMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:KRABAK
Suffix:
Gender:F
Credentials:PHARMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 1/2 REAR FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1946
Mailing Address - Country:US
Mailing Address - Phone:215-435-1109
Mailing Address - Fax:
Practice Address - Street 1:73 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1751
Practice Address - Country:US
Practice Address - Phone:570-630-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R102820100183500000X
PARP045901L183500000X
PAAK001230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist