Provider Demographics
NPI:1558724591
Name:MINUDRI, JILL JANICE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:JANICE
Last Name:MINUDRI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 273
Mailing Address - Street 2:
Mailing Address - City:COBB
Mailing Address - State:CA
Mailing Address - Zip Code:95426
Mailing Address - Country:US
Mailing Address - Phone:707-263-9152
Mailing Address - Fax:
Practice Address - Street 1:5176 HILL ROAD EAST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453
Practice Address - Country:US
Practice Address - Phone:707-262-5069
Practice Address - Fax:707-262-5063
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist