Provider Demographics
NPI:1508466517
Name:PRUNIER, JILLIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:PRUNIER
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 1:917 MILLERS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-9621
Mailing Address - Country:US
Mailing Address - Phone:413-218-5419
Mailing Address - Fax:
Practice Address - Street 1:555 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9515
Practice Address - Country:US
Practice Address - Phone:978-544-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist