Provider Demographics
NPI:1689709263
Name:MEIK, JACQUELINE MAE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MAE
Last Name:MEIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6297 LAURITZEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1216
Mailing Address - Country:US
Mailing Address - Phone:801-964-5753
Mailing Address - Fax:
Practice Address - Street 1:6949 HIGH TECH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3705
Practice Address - Country:US
Practice Address - Phone:801-233-6100
Practice Address - Fax:801-233-6139
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153831-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist