Healthcare Provider Details

I. General information

NPI: 1841900271
Provider Name (Legal Business Name): JACKLYN LOUISE PATTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FRIENDSHIP CIR
BEAVER PA
15009-9704
US

IV. Provider business mailing address

246 FRIENDSHIP CIR
BEAVER PA
15009-9704
US

V. Phone/Fax

Practice location:
  • Phone: 724-512-8767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number0890773
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: