Provider Demographics
NPI:1073374013
Name:JUAREZ, JACQUELYN NADINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NADINE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 MANNY AGUILERA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2760
Mailing Address - Country:US
Mailing Address - Phone:915-472-2325
Mailing Address - Fax:
Practice Address - Street 1:121 E REDD RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1981
Practice Address - Country:US
Practice Address - Phone:915-472-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist