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NPI Code Detail

MEDICARE: MRS. BRENDA LEE JACKS RPH

MEDICARE: MRS. BRENDA LEE JACKS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist58046WA
2183500000XPharmacist8575OR

General Provider Information

NPI Number : 1326312281
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA LEE JACKS RPH
Provider Business Mailing Address
First Line : 7700 NE HIGHWAY 99
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-8872
Country : US
Telephone Number : 360-699-8133
Fax Number : 360-699-8149
Provider Business Practice Location Address
First Line : 7700 NE HIGHWAY 99
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-8872
Country : US
Telephone Number : 360-699-8133
Fax Number : 360-699-8149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2012
Last Update Date : 02/23/2012

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