MEDICARE: JACQUELINE KOLEONG

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
1	183500000X	Pharmacist	RPH77171	CA

General Provider Information

NPI Number	:	1588457717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE KOLEONG

Provider Business Mailing Address
First Line	:	11401 VUEPOINTE WAY UNIT D
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-6218
Country	:	US
Telephone Number	:	562-215-5615
Fax Number	:

Provider Business Practice Location Address
First Line	:	3039 W VALLEY BLVD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-1822
Country	:	US
Telephone Number	:	626-281-3799
Fax Number	:	626-281-0711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/28/2025

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Directions to “ JACQUELINE KOLEONG ” Practice Location

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