Provider Demographics
NPI:1932324811
Name:BLISS, JERRY ALLAN (PHARMD,RPH,CCP)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLAN
Last Name:BLISS
Suffix:
Gender:M
Credentials:PHARMD,RPH,CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BOBWHITE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3103
Mailing Address - Country:US
Mailing Address - Phone:856-428-5762
Mailing Address - Fax:856-428-5762
Practice Address - Street 1:1025 BOBWHITE DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3103
Practice Address - Country:US
Practice Address - Phone:856-428-5762
Practice Address - Fax:856-428-5762
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01957000183500000X
PARP038881R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist