Provider Demographics
NPI:1184469678
Name:STEWART, JACQUELINE BETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BETH
Last Name:STEWART
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 1:221 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6260
Mailing Address - Country:US
Mailing Address - Phone:337-540-8959
Mailing Address - Fax:
Practice Address - Street 1:4070 NELSON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2444
Practice Address - Country:US
Practice Address - Phone:337-562-7979
Practice Address - Fax:337-562-2343
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist