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NPI Code Detail

MEDICARE: MRS. JACQUELYN LEE BRISCOE PHARM D

MEDICARE:  MRS. JACQUELYN LEE BRISCOE  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
1183500000XPharmacist03-2-26302OH

General Provider Information

NPI Number : 1639235146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELYN LEE BRISCOE PHARM D
Provider Business Mailing Address
First Line : 9365 W KLINGER RD
Second Line :
City : COVINGTON
State : OH
Zip : 45318-9643
Country : US
Telephone Number : 937-473-3031
Fax Number : 419-375-4488
Provider Business Practice Location Address
First Line : 110 EAST BUTLER ST
Second Line :
City : FORT RECOVERY
State : OH
Zip : 45846-0605
Country : US
Telephone Number : 419-375-2323
Fax Number : 419-375-4488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. JACQUELYN LEE BRISCOE PHARM D” Practice Location

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