Provider Demographics
NPI:1972966398
Name:JACKOVIC, JULIE PEPE (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:PEPE
Last Name:JACKOVIC
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 1:4080 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2580
Mailing Address - Country:US
Mailing Address - Phone:724-941-2522
Mailing Address - Fax:
Practice Address - Street 1:4080 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2580
Practice Address - Country:US
Practice Address - Phone:724-941-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045297R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist