Provider Demographics
NPI:1770639627
Name:SKELTON, JACQUELINE SUZANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:SUZANNE
Other - Last Name:KLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:30 WIND WAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3750 MOUNT READ BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3436
Practice Address - Country:US
Practice Address - Phone:585-581-5101
Practice Address - Fax:585-581-2646
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist