Provider Demographics
NPI:1871087932
Name:LAVELLA, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LAVELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2318
Mailing Address - Country:US
Mailing Address - Phone:412-427-5155
Mailing Address - Fax:
Practice Address - Street 1:818 E WARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-1560
Practice Address - Country:US
Practice Address - Phone:412-431-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP1003049183500000X
PARP034247L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP034247LOtherPHARMACIST LICENSE
PARP1003049OtherAUTHORIZATION TO ADMINISTER INJECTABLES