Provider Demographics
NPI:1841460045
Name:MCTISH, JENNIFER A (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MCTISH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 ARNOT RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-8540
Mailing Address - Country:US
Mailing Address - Phone:570-723-8512
Mailing Address - Fax:
Practice Address - Street 1:1169 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9537
Practice Address - Country:US
Practice Address - Phone:570-662-1120
Practice Address - Fax:570-662-1122
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist