Provider Demographics
NPI:1982857017
Name:MCCROMMON, JANET LEE
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LEE
Last Name:MCCROMMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2422
Mailing Address - Country:US
Mailing Address - Phone:814-849-7548
Mailing Address - Fax:814-849-9650
Practice Address - Street 1:40 S WHITE ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2422
Practice Address - Country:US
Practice Address - Phone:814-849-7548
Practice Address - Fax:814-849-9650
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027520L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist