Provider Demographics
NPI:1013124379
Name:WODLINGER JACKSON, ANNA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:WODLINGER JACKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:WODLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1054
Mailing Address - Country:US
Mailing Address - Phone:215-508-1295
Mailing Address - Fax:
Practice Address - Street 1:3307 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5101
Practice Address - Country:US
Practice Address - Phone:215-707-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045225L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy