Provider Demographics
NPI:1871195586
Name:MCGILLIAN, JEANINE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE
Last Name:MCGILLIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1772
Mailing Address - Country:US
Mailing Address - Phone:215-513-0676
Mailing Address - Fax:215-713-0676
Practice Address - Street 1:1006 BRANCH MILL RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-2342
Practice Address - Country:US
Practice Address - Phone:215-703-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040745L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2152854270OtherANY HEALTH INSURANCE