Provider Demographics
NPI:1710683180
Name:MCTAGGART, JESSICA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MCTAGGART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 SHARPLESS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2015
Mailing Address - Country:US
Mailing Address - Phone:484-326-6507
Mailing Address - Fax:
Practice Address - Street 1:927 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2919
Practice Address - Country:US
Practice Address - Phone:610-284-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist