Provider Demographics
NPI:1003561457
Name:KNOWLTON, JILLANN (RPH)
Entity type:Individual
Prefix:MS
First Name:JILLANN
Middle Name:
Last Name:KNOWLTON
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 1:9 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026
Mailing Address - Country:US
Mailing Address - Phone:860-930-5593
Mailing Address - Fax:
Practice Address - Street 1:577 MAIN ST STE 360
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3046
Practice Address - Country:US
Practice Address - Phone:978-212-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6861183500000X
MA20072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
273620OtherNABP