Provider Demographics
NPI:1104321520
Name:FITZGERALD, JOANNE (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 DELFT LN
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-4503
Mailing Address - Country:US
Mailing Address - Phone:215-771-4223
Mailing Address - Fax:
Practice Address - Street 1:6950 GERMANTOWN AVE STE 326
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2114
Practice Address - Country:US
Practice Address - Phone:215-771-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032954L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist