Provider Demographics
NPI:1134486616
Name:PICKETT, JACINDA LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:LEIGH
Last Name:PICKETT
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 1:7249 ROUNDUP LN NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7317
Mailing Address - Country:US
Mailing Address - Phone:425-422-1996
Mailing Address - Fax:
Practice Address - Street 1:10990 HARBOR HILL DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-853-8609
Practice Address - Fax:253-853-8606
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60574257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist