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NPI Code Detail

MEDICARE: JAQUELINE WILLIS

MEDICARE: JAQUELINE WILLIS
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
1183500000XPharmacist34293TN

General Provider Information

NPI Number : 1417637679
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAQUELINE WILLIS
Provider Business Mailing Address
First Line : 735 HARDING PL
Second Line :
City : NASHVILLE
State : TN
Zip : 37211-4357
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 735 HARDING PL
Second Line :
City : NASHVILLE
State : TN
Zip : 37211-4357
Country : US
Telephone Number : 615-781-1282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 07/24/2023

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Directions to “ JAQUELINE WILLIS ” Practice Location

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