MEDICARE: DR. JILL E PONCE PHARMD

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	117072-2	MN
2	183500000X	Pharmacist	19358	IA

General Provider Information

NPI Number	:	1942243902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL E PONCE PHARMD

Provider Business Mailing Address
First Line	:	8421 ALLEGHENY GROVE BLVD
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-8203
Country	:	US
Telephone Number	:	952-443-4657
Fax Number	:

Provider Business Practice Location Address
First Line	:	8421 ALLEGHENY GROVE BLVD
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-8203
Country	:	US
Telephone Number	:	952-443-4657
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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