MEDICARE: MRS. JENNA CIOLAC PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S026147	AZ

General Provider Information

NPI Number	:	1245956374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA CIOLAC PHARM D

Provider Business Mailing Address
First Line	:	11109 W BRITTLEWOOD DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-1188
Country	:	US
Telephone Number	:	480-299-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	25401 N LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1351
Country	:	US
Telephone Number	:	623-235-2360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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