Provider Demographics
NPI:1598777138
Name:YACOBUCCI, JEAN MILLS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MILLS
Last Name:YACOBUCCI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:307 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9278
Mailing Address - Country:US
Mailing Address - Phone:814-696-1092
Mailing Address - Fax:
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:PHARMACY SERVICE 10-P
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4305
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:814-940-7868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS6969183500000X
FL22485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist