Provider Demographics
NPI:1730789371
Name:PONTIFF, LUCETTA (PHARMD)
Entity type:Individual
Prefix:
First Name:LUCETTA
Middle Name:
Last Name:PONTIFF
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 1:111 WATER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1207
Mailing Address - Country:US
Mailing Address - Phone:412-605-8042
Mailing Address - Fax:
Practice Address - Street 1:72 BEDFORD SQ
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6934
Practice Address - Country:US
Practice Address - Phone:814-623-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI010691183500000X
PARP450728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist