Healthcare Provider Details

I. General information

NPI: 1043791429
Provider Name (Legal Business Name): JACQUELYN NICOLE MACINTIRE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 1ST ST
ILION NY
13357-1711
US

IV. Provider business mailing address

40 1ST ST
ILION NY
13357-1711
US

V. Phone/Fax

Practice location:
  • Phone: 315-894-2381
  • Fax:
Mailing address:
  • Phone: 315-894-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: