Provider Demographics
NPI:1457953366
Name:POLANSKY DOOLEY, JUDITH (RPH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:POLANSKY DOOLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CRUMS MILL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2896
Mailing Address - Country:US
Mailing Address - Phone:717-651-6114
Mailing Address - Fax:
Practice Address - Street 1:4000 CRUMS MILL RD STE 301
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2896
Practice Address - Country:US
Practice Address - Phone:717-651-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP384174L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP38417LOtherSTATE BOARD