Provider Demographics
NPI:1831280551
Name:JACKMAN, DENISE JOANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:JOANN
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 W 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-3720
Mailing Address - Country:US
Mailing Address - Phone:509-582-2753
Mailing Address - Fax:509-585-0847
Practice Address - Street 1:1410 W 27TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-3701
Practice Address - Country:US
Practice Address - Phone:509-585-0846
Practice Address - Fax:509-585-0847
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00010508OtherPHARMACY LICENSE