Provider Demographics
NPI:1093005365
Name:PACE, JIMMIE DEBORAH (BS PHARMACY RPH)
Entity Type:Individual
Prefix:MS
First Name:JIMMIE
Middle Name:DEBORAH
Last Name:PACE
Suffix:
Gender:F
Credentials:BS PHARMACY RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7836 DESIARD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4935
Mailing Address - Country:US
Mailing Address - Phone:318-343-0942
Mailing Address - Fax:318-343-0917
Practice Address - Street 1:7836 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4935
Practice Address - Country:US
Practice Address - Phone:318-343-0942
Practice Address - Fax:318-343-0917
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist