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General NPI Number Information
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NPI Number | 1831280551
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Entity Type | Individual
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Provider Name | DENISE JOANN JACKMAN RPH
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1410 W 27TH AVE
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City | KENNEWICK
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State | WA
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Zip | 99337-3701
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Country | US
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Telephone | 509-585-0846
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Fax | 509-585-0847
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Provider Business Mailing Address
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Address Line | 2011 W 35TH AVE
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City | KENNEWICK
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State | WA
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Zip | 99337-3720
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Country | US
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Telephone | 509-582-2753
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Fax | 509-585-0847
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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 | PH00010508
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License Number State | WA
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