Provider Demographics
NPI:1912289786
Name:ANDERSON, JANE A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:A
Last Name:ANDERSON
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 1:35 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5716
Mailing Address - Country:US
Mailing Address - Phone:978-840-9959
Mailing Address - Fax:978-840-9965
Practice Address - Street 1:35 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5716
Practice Address - Country:US
Practice Address - Phone:978-840-9959
Practice Address - Fax:978-840-9965
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH20721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist