Provider Demographics
NPI:1942673041
Name:RATHFON, JUANITA (RPH)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:RATHFON
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 1:6724 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2840
Mailing Address - Country:US
Mailing Address - Phone:215-924-9929
Mailing Address - Fax:
Practice Address - Street 1:6724 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2840
Practice Address - Country:US
Practice Address - Phone:215-924-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044996L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist