Provider Demographics
NPI:1992118665
Name:PEACEY, JENNIFER L (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PEACEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 N GEORGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-9208
Mailing Address - Country:US
Mailing Address - Phone:717-781-0302
Mailing Address - Fax:
Practice Address - Street 1:4135 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-9208
Practice Address - Country:US
Practice Address - Phone:717-781-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist