Provider Demographics
NPI:1548573546
Name:SCHRADER, JACKI L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:L
Last Name:SCHRADER
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 1:476 THREE PINES RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-8754
Mailing Address - Country:US
Mailing Address - Phone:541-955-9534
Mailing Address - Fax:541-955-9534
Practice Address - Street 1:476 THREE PINES RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-8754
Practice Address - Country:US
Practice Address - Phone:541-955-9534
Practice Address - Fax:541-955-9534
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist