Provider Demographics
NPI:1972835049
Name:DYNDA, JERA MARIE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:JERA
Middle Name:MARIE
Last Name:DYNDA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAIN ST
Mailing Address - Street 2:TOPS MARKETS #610
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2024
Mailing Address - Country:US
Mailing Address - Phone:814-363-9904
Mailing Address - Fax:
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:TOPS MARKETS #610
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2024
Practice Address - Country:US
Practice Address - Phone:814-363-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440659183500000X
NY054169-1183500000X
AZS015209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist