Provider Demographics
NPI:1417252743
Name:PACHICK, JENNIFER ANN
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:PACHICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2055
Mailing Address - Country:US
Mailing Address - Phone:704-263-1416
Mailing Address - Fax:704-263-1411
Practice Address - Street 1:442 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2055
Practice Address - Country:US
Practice Address - Phone:704-263-1416
Practice Address - Fax:704-263-1411
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365874Medicaid