Provider Demographics
NPI:1952064560
Name:JANDORA, THOMAS II
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JANDORA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 TUDOR LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7657
Mailing Address - Country:US
Mailing Address - Phone:814-312-2438
Mailing Address - Fax:
Practice Address - Street 1:181 SOPHRIRA LN
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6543
Practice Address - Country:US
Practice Address - Phone:814-946-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist