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General NPI Number Information
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NPI Number | 1497355283
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Entity Type | Individual
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Provider Name | JACQUELINE DAKER
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 2424 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6429
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Country | US
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Telephone | 815-744-7601
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Fax |
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Provider Business Mailing Address
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Address Line | 26752 LINDENGATE CIR
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City | PLAINFIELD
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State | IL
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Zip | 60585-5994
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Country | US
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Telephone | 815-545-0714
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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 | 051291189
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License Number State | IL
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