Healthcare Provider Details

I. General information

NPI: 1265750806
Provider Name (Legal Business Name): JANIS HILL-JACKSON PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 VARNUM ST NE
WASHINGTON DC
20017-2755
US

IV. Provider business mailing address

1217 VARNUM ST NE
WASHINGTON DC
20017-2755
US

V. Phone/Fax

Practice location:
  • Phone: 202-498-3729
  • Fax:
Mailing address:
  • Phone: 202-498-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH2941
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14843
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: