Provider Demographics
NPI:1689216103
Name:JASKOWIAK, JACLYN MARJA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARJA
Last Name:JASKOWIAK
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 1:9452 MEDICAL CENTER DR RM 312
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1337
Mailing Address - Country:US
Mailing Address - Phone:858-822-6802
Mailing Address - Fax:
Practice Address - Street 1:9452 MEDICAL CENTER DR RM 312
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1337
Practice Address - Country:US
Practice Address - Phone:858-822-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist