Provider Demographics
NPI:1720263627
Name:STERN, JAY STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:STEVEN
Last Name:STERN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3501
Mailing Address - Country:US
Mailing Address - Phone:724-628-6300
Mailing Address - Fax:724-628-3077
Practice Address - Street 1:110 W CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3501
Practice Address - Country:US
Practice Address - Phone:724-628-6300
Practice Address - Fax:724-628-3077
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030270L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist