Provider Demographics
NPI:1164671319
Name:JAECKS, JOANNA CHRISTINE (PHARMD CANDIDATE)
Entity Type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:CHRISTINE
Last Name:JAECKS
Suffix:
Gender:F
Credentials:PHARMD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 TWIN MAPLE LN NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2430
Mailing Address - Country:US
Mailing Address - Phone:719-351-8916
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WASHINGTON SCHOOL OF PHARMACY
Practice Address - Street 2:H-364 HEALTH SCIENCES, BOX 357631
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:719-351-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR00069458390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program