Provider Demographics
NPI:1790063873
Name:BACCI, JENNIFER L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BACCI
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357630
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7630
Mailing Address - Country:US
Mailing Address - Phone:206-221-3372
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 357630
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7630
Practice Address - Country:US
Practice Address - Phone:206-221-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445532183500000X
WAPH60561799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist