1275816845 NPI number — DR. JILLIAN ALEXANDRA STARTARE PHARMD

Table of content: YSANNE JOHNSON (NPI 1861892572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275816845 NPI number — DR. JILLIAN ALEXANDRA STARTARE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARTARE
Provider First Name:
JILLIAN
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275816845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 MEYERS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-7186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-972-9470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E MCMURRAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-949-1583
Provider Business Practice Location Address Fax Number:
724-949-1589
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP441054 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RP441054 . This is a "PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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