Provider Demographics
NPI:1508166687
Name:FANELLI, JILL LYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LYN
Last Name:FANELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LYN
Other - Last Name:ALVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1871 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4106
Mailing Address - Country:US
Mailing Address - Phone:925-979-0095
Mailing Address - Fax:
Practice Address - Street 1:1871 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4106
Practice Address - Country:US
Practice Address - Phone:925-979-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist