Provider Demographics
NPI:1134441942
Name:UPHOLD, JENNIFER (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:UPHOLD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SICKLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONFLUENCE
Mailing Address - State:PA
Mailing Address - Zip Code:15424-2064
Mailing Address - Country:US
Mailing Address - Phone:814-442-0341
Mailing Address - Fax:301-746-5803
Practice Address - Street 1:248 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21531-2148
Practice Address - Country:US
Practice Address - Phone:301-746-5881
Practice Address - Fax:301-746-5803
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16266183500000X
PARP046241L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist