Basic Information
| Provider Information | |||||||||
| NPI: | 1750781498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFTER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD., RPH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 STATE HIGHWAY 310 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136171459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153864563 | ||||||||
| FaxNumber: | 3153864332 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 NEW YORK 12 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA BAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154826270 | ||||||||
| FaxNumber: | 3154824692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2014 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 058006 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.