MEDICARE: THERESA M JACKOVIC PHARM D

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	RP046357	PA

General Provider Information

NPI Number	:	1962725606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA M JACKOVIC PHARM D

Provider Business Mailing Address
First Line	:	4670 OLD BOSTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-1112
Country	:	US
Telephone Number	:	412-526-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 CLAIRTON BLVD
Second Line	:
City	:	PLEASANT HILLS
State	:	PA
Zip	:	15236-4517
Country	:	US
Telephone Number	:	412-653-7906
Fax Number	:

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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