Provider Demographics
NPI:1457646671
Name:KATZ, JILL BROOKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BROOKE
Last Name:KATZ
Suffix:
Gender:F
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 1:51 TIERRA REJADA RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2902
Mailing Address - Country:US
Mailing Address - Phone:805-416-5794
Mailing Address - Fax:805-416-5792
Practice Address - Street 1:51 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2902
Practice Address - Country:US
Practice Address - Phone:805-416-5794
Practice Address - Fax:805-416-5792
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist