Provider Demographics
NPI:1770231375
Name:STANTON, JACQUELINE JANE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:JANE
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-1952
Mailing Address - Country:US
Mailing Address - Phone:717-244-2919
Mailing Address - Fax:717-244-2821
Practice Address - Street 1:910 W BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-1952
Practice Address - Country:US
Practice Address - Phone:717-244-2919
Practice Address - Fax:717-244-2821
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician