Provider Demographics
NPI:1609597772
Name:CHURCHILL, JACQUELYN NICHOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:NICHOLE
Last Name:CHURCHILL
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 1:1350 KINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3038
Mailing Address - Country:US
Mailing Address - Phone:281-358-3143
Mailing Address - Fax:
Practice Address - Street 1:1350 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3038
Practice Address - Country:US
Practice Address - Phone:281-358-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist