Provider Demographics
NPI:1831102086
Name:JEFFREYS DRUG STORE LTC
Entity Type:Organization
Organization Name:JEFFREYS DRUG STORE LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZUBRITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-745-6078
Mailing Address - Street 1:1 N CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1301
Mailing Address - Country:US
Mailing Address - Phone:724-745-6078
Mailing Address - Fax:724-745-8818
Practice Address - Street 1:1 N CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1301
Practice Address - Country:US
Practice Address - Phone:724-745-6078
Practice Address - Fax:724-745-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4813503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010028080001Medicaid