Provider Demographics
NPI:1619454063
Name:ALVAREZ, JACQUELINE KAY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:KAY
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 BRIDGEMOR DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2681
Mailing Address - Country:US
Mailing Address - Phone:786-261-8248
Mailing Address - Fax:
Practice Address - Street 1:645 BARRETT PKWY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4922
Practice Address - Country:US
Practice Address - Phone:770-794-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0306661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist