Provider Demographics
NPI:1225333222
Name:DACIER, JACLYN JANINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:JANINE
Last Name:DACIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 CHILCOMB CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6546
Mailing Address - Country:US
Mailing Address - Phone:704-641-0079
Mailing Address - Fax:
Practice Address - Street 1:123 WEISS WAY
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6546
Practice Address - Country:US
Practice Address - Phone:704-641-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist