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NPI Code Detail

MEDICARE: MRS. JILL JANECYK RPH

MEDICARE: MRS. JILL JANECYK RPH
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
1183500000XPharmacist5302028743MI

General Provider Information

NPI Number : 1427330265
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL JANECYK RPH
Provider Business Mailing Address
First Line : 5973 PHEASANT VIEW DR NE
Second Line :
City : ADA
State : MI
Zip : 49301-8648
Country : US
Telephone Number : 616-874-4244
Fax Number :
Provider Business Practice Location Address
First Line : 5100 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-1006
Country : US
Telephone Number : 616-361-1758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2011
Last Update Date : 09/19/2011

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