Provider Demographics
NPI:1336476712
Name:TATE, JACQUELINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TATE
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 1:1330 W SAN LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-2926
Mailing Address - Country:US
Mailing Address - Phone:520-326-8543
Mailing Address - Fax:
Practice Address - Street 1:3923 N FLOWING WELLS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-2451
Practice Address - Country:US
Practice Address - Phone:520-887-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist