Provider Demographics
NPI:1942243902
Name:PONCE, JILL E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:PONCE
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 1:8421 ALLEGHENY GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-8203
Mailing Address - Country:US
Mailing Address - Phone:952-443-4657
Mailing Address - Fax:
Practice Address - Street 1:8421 ALLEGHENY GROVE BLVD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-8203
Practice Address - Country:US
Practice Address - Phone:952-443-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117072-2183500000X
IA19358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist