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General NPI Number Information
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NPI Number | 1306441209
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Entity Type | Individual
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Provider Name | MICHELLE YVONNE JACQUES RPH
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 970 SAINT JAMES AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2800
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Country | US
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Telephone | 413-737-6346
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Fax | 413-785-5850
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Provider Business Mailing Address
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Address Line | 4 SANDY CT
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City | WILBRAHAM
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State | MA
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Zip | 01095-1792
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Country | US
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Telephone | 401-279-1026
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Fax |
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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 | PH23051
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License Number State | MA
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