Provider Demographics
NPI:1982826418
Name:WALCOTT, JURENE (RPH)
Entity Type:Individual
Prefix:
First Name:JURENE
Middle Name:
Last Name:WALCOTT
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:REMAINDER MATRICULATE #1 CANE ES
Mailing Address - Street 2:
Mailing Address - City:ST. CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00840
Mailing Address - Country:US
Mailing Address - Phone:340-692-2622
Mailing Address - Fax:340-772-2210
Practice Address - Street 1:REMAINDER MATRICULATE #1 CANE ES
Practice Address - Street 2:
Practice Address - City:ST. CROIX
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-692-2622
Practice Address - Fax:340-772-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist