Provider Demographics
NPI:1083963508
Name:DUCKSWORTH, JACQUELINE BETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BETTE
Last Name:DUCKSWORTH
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 1:3290 KEITH BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3937
Mailing Address - Country:US
Mailing Address - Phone:770-886-3202
Mailing Address - Fax:
Practice Address - Street 1:3290 KEITH BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3937
Practice Address - Country:US
Practice Address - Phone:770-886-3202
Practice Address - Fax:770-886-3479
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist