Provider Demographics
NPI:1952687659
Name:LINEMAN, JACLYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:LINEMAN
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 1:6364 COTSWOLD LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9751
Mailing Address - Country:US
Mailing Address - Phone:262-391-5091
Mailing Address - Fax:
Practice Address - Street 1:1901 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3133
Practice Address - Country:US
Practice Address - Phone:608-365-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13897-040183500000X
HIPH2880183500000X
IL051.293138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist