Healthcare Provider Details

I. General information

NPI: 1316490980
Provider Name (Legal Business Name): JACQUELINE MARIE CHORZEMPA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE MARIE HAGARTY PHARMD

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST
PHOENIX AZ
85006
US

IV. Provider business mailing address

1441 N 12TH ST
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 319-899-6433
  • Fax:
Mailing address:
  • Phone: 319-899-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26325
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS022616
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: