Provider Demographics
NPI:1023148558
Name:CALHOUN, JACEY LEIGH (PHARMD)
Entity type:Individual
Prefix:
First Name:JACEY
Middle Name:LEIGH
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JACEY
Other - Middle Name:LEIGH
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:484 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7308
Mailing Address - Country:US
Mailing Address - Phone:334-692-3680
Mailing Address - Fax:
Practice Address - Street 1:1909 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4289
Practice Address - Country:US
Practice Address - Phone:334-836-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist