Provider Demographics
NPI:1750781498
Name:RAFTER, JESSICA LAUREN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LAUREN
Last Name:RAFTER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 STATE HIGHWAY 310
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1459
Mailing Address - Country:US
Mailing Address - Phone:315-386-4563
Mailing Address - Fax:315-386-4332
Practice Address - Street 1:21 NEW YORK 12
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607
Practice Address - Country:US
Practice Address - Phone:315-482-6270
Practice Address - Fax:315-482-4692
Is Sole Proprietor?:No
Enumeration Date:2014-08-31
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist