Active NPI
Jessica Nicodemus
- Pharmacist
- Jeannette, PA
National Provider Identifier
1255708954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP449439
- Practice address
- 621 Clay Ave
Jeannette, PA 15644-3409 - Phone
- (724) 527-3888
- NPI assigned
- Aug 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP449439 | PA | Primary |
Addresses
Primary practice location
621 Clay Ave
Jeannette, PA 15644-3409
Mailing address
PO Box 326
Stockdale, PA 15483-0326
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 |
|---|---|---|---|
| RP449439 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients | |
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Jeannette, PA
- NPI 1235228974
-
- Community/Retail Pharmacy
- Clearfield, PA
- NPI 1508431081
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440720000000",
"number": "1255708954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 326",
"city": "STOCKDALE",
"state": "PA",
"postal_code": "154830326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 CLAY AVE",
"city": "JEANNETTE",
"state": "PA",
"postal_code": "156443409",
"telephone_number": "724-527-3888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICODEMUS",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-28",
"last_updated": "2015-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP449439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jeannette, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.