Provider Demographics
NPI:1922495936
Name:EBERLY, JODI LORRAINE (RPH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LORRAINE
Last Name:EBERLY
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 1:60484 SNAP SHOT LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2539
Mailing Address - Country:US
Mailing Address - Phone:717-515-0760
Mailing Address - Fax:
Practice Address - Street 1:944 SW VETERANS WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2538
Practice Address - Country:US
Practice Address - Phone:541-504-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist