Provider Demographics
NPI:1669710745
Name:PERATY, JYOTHSNA
Entity type:Individual
Prefix:MS
First Name:JYOTHSNA
Middle Name:
Last Name:PERATY
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 1:2173 SAN MORITZ CIR
Mailing Address - Street 2:APT # 202
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5952
Mailing Address - Country:US
Mailing Address - Phone:732-429-4694
Mailing Address - Fax:
Practice Address - Street 1:1606 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2012
Practice Address - Country:US
Practice Address - Phone:610-437-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP446571OtherPENNSYLVANIA BOARD OF PHARMACY