Provider Demographics
NPI:1134424260
Name:CAVANAGH, JACQUELINE AYN (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:AYN
Last Name:CAVANAGH
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 1:810 E GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5332
Mailing Address - Country:US
Mailing Address - Phone:602-331-0440
Mailing Address - Fax:
Practice Address - Street 1:810 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5332
Practice Address - Country:US
Practice Address - Phone:602-331-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist