Healthcare Provider Details

I. General information

NPI: 1598777138
Provider Name (Legal Business Name): JEAN MILLS YACOBUCCI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 PLEASANT VALLEY BLVD PHARMACY SERVICE 10-P
ALTOONA PA
16602-4305
US

IV. Provider business mailing address

307 CLEARVIEW DR
HOLLIDAYSBURG PA
16648-9278
US

V. Phone/Fax

Practice location:
  • Phone: 814-943-8164
  • Fax: 814-940-7868
Mailing address:
  • Phone: 814-696-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6969
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: