Provider Demographics
NPI:1811352800
Name:REIFSNYDER, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:REIFSNYDER
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 1:100 N PARK RD
Mailing Address - Street 2:APARTMENT 1339
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3044
Mailing Address - Country:US
Mailing Address - Phone:610-568-0178
Mailing Address - Fax:
Practice Address - Street 1:3145 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-7745
Practice Address - Country:US
Practice Address - Phone:610-286-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist