Provider Demographics
NPI:1760779565
Name:ALLEY, JONATHAN J (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:ALLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2102
Mailing Address - Country:US
Mailing Address - Phone:607-753-1591
Mailing Address - Fax:
Practice Address - Street 1:14 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2102
Practice Address - Country:US
Practice Address - Phone:607-753-1591
Practice Address - Fax:607-753-0570
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI055658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist