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General NPI Number Information
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NPI Number | 1588457717
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Entity Type | Individual
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Provider Name | JACQUELINE KOLEONG
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 3039 W VALLEY BLVD
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City | ALHAMBRA
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State | CA
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Zip | 91803-1822
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Country | US
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Telephone | 626-281-3799
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Fax | 626-281-0711
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Provider Business Mailing Address
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Address Line | 11401 VUEPOINTE WAY UNIT D
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City | EL MONTE
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State | CA
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Zip | 91732-6218
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Country | US
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Telephone | 562-215-5615
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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 | RPH77171
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License Number State | CA
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