Active NPI
Jerry Skolnick
- Pharmacist
- Philadelphia, PA
National Provider Identifier
1114388493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RIO1465000
- Practice address
- 340 N 12TH St
Suiute 110
Philadelphia, PA 19107-1102 - Phone
- (844) 274-4103
- Fax
- (267) 758-6330
- NPI assigned
- Mar 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP028193L | PA | |
| Pharmacist | 183500000X | 28RIO1465000 | NJ | Primary |
Addresses
Primary practice location
340 N 12TH St
Suiute 110
Philadelphia, PA 19107-1102
Mailing address
340 N 12TH St
Suiute 110
Philadelphia, PA 19107-1102
Phone (844) 274-4103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RIO1465000 | NJ | MD | Pharmacist |
| RP028193L | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1114388493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 N 12TH ST",
"address_2": "SUIUTE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071102",
"telephone_number": "844-274-4103",
"fax_number": "267-758-6330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 N 12TH ST",
"address_2": "SUIUTE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071102",
"telephone_number": "844-274-4103",
"fax_number": "267-758-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKOLNICK",
"first_name": "JERRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-14",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP028193L",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RIO1465000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.