Provider Demographics
NPI:1568705309
Name:HARPER, JACKIE GAYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:GAYLE
Last Name:HARPER
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 1:777 GOLD HILL PL S
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-1101
Mailing Address - Country:US
Mailing Address - Phone:719-687-6007
Mailing Address - Fax:
Practice Address - Street 1:777 GOLD HILL PL S
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1101
Practice Address - Country:US
Practice Address - Phone:719-687-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist