Healthcare Provider Details

I. General information

NPI: 1245871896
Provider Name (Legal Business Name): JACQUELINE MARIE DUNKER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALMART PHARMACY 1443 4370 EASTGATE SQUARE DRIVE
CINCINNATI OH
45245
US

IV. Provider business mailing address

7770 FOX TRAIL LN
CINCINNATI OH
45255-4316
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-3370
  • Fax:
Mailing address:
  • Phone: 513-300-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020360
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03317051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: