Provider Demographics
NPI:1356870596
Name:BENDER, JESSE THOMAS
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:BENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 MONTOUR RD
Mailing Address - Street 2:
Mailing Address - City:LOYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17047-9200
Mailing Address - Country:US
Mailing Address - Phone:717-789-3093
Mailing Address - Fax:717-789-9451
Practice Address - Street 1:1102 MONTOUR RD
Practice Address - Street 2:
Practice Address - City:LOYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17047-9200
Practice Address - Country:US
Practice Address - Phone:717-789-3093
Practice Address - Fax:717-789-9451
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist