Provider Demographics
NPI:1013693548
Name:THORNLEY, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THORNLEY
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 1:514 ELK RUN RD
Mailing Address - Street 2:
Mailing Address - City:GAINES
Mailing Address - State:PA
Mailing Address - Zip Code:16921-9627
Mailing Address - Country:US
Mailing Address - Phone:908-675-2745
Mailing Address - Fax:
Practice Address - Street 1:11798 ROUTE 6
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6753
Practice Address - Country:US
Practice Address - Phone:570-724-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30227577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist