Healthcare Provider Details

I. General information

NPI: 1952986895
Provider Name (Legal Business Name): JILL L KRONGARD PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8172 AUBERGE CIR
SAN DIEGO CA
92127-4204
US

IV. Provider business mailing address

8172 AUBERGE CIR
SAN DIEGO CA
92127-4204
US

V. Phone/Fax

Practice location:
  • Phone: 443-762-9006
  • Fax:
Mailing address:
  • Phone: 443-762-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number116856
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number15757
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number70078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: