Provider Demographics
NPI:1588623052
Name:STJACQUES, MONICA (PHARMD, BCPS, CDE)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:STJACQUES
Suffix:
Gender:F
Credentials:PHARMD, BCPS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:SUITE #119
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-224-1958
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:SUITE #119
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-224-1958
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist