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General NPI Number Information
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NPI Number | 1154616308
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Entity Type | Individual
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Provider Name | JACQUELINE SUSANNE HURLBUT RPH.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 3633 CLEMMONS RD
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City | CLEMMONS
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State | NC
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Zip | 27012-8725
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Country | US
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Telephone | 335-293-1395
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Fax | 336-293-1394
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Provider Business Mailing Address
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Address Line | 3633 CLEMMONS RD
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City | CLEMMONS
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State | NC
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Zip | 27012-8725
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Country | US
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Telephone | 336-293-1395
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Fax | 336-293-1394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13059
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License Number State | NC
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