Provider Demographics
NPI:1417227935
Name:ULMER, JACK LIVINGSTON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:LIVINGSTON
Last Name:ULMER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7777
Mailing Address - Fax:530-899-2019
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-332-7777
Practice Address - Fax:530-899-2019
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0404741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist