Provider Demographics
NPI:1184617359
Name:BRANSON, JACQUELINE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87335
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-0335
Mailing Address - Country:US
Mailing Address - Phone:773-967-5200
Mailing Address - Fax:
Practice Address - Street 1:940 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4953
Practice Address - Country:US
Practice Address - Phone:630-427-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist