Provider Demographics
NPI:1922584911
Name:PRINCE, JAMES ROBERT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:PRINCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 GRANGE HALL RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-8607
Mailing Address - Country:US
Mailing Address - Phone:717-692-4638
Mailing Address - Fax:
Practice Address - Street 1:200 KOCHER LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023-8716
Practice Address - Country:US
Practice Address - Phone:717-362-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034514R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist