Provider Demographics
NPI:1871180760
Name:SHORE, JACLYN MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MICHELLE
Last Name:SHORE
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 1:420 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1510
Mailing Address - Country:US
Mailing Address - Phone:215-876-0420
Mailing Address - Fax:
Practice Address - Street 1:920 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-7702
Practice Address - Country:US
Practice Address - Phone:215-233-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist