Provider Demographics
NPI:1669193686
Name:ALTMAN, JACKLYN M (PHARMD)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:M
Last Name:ALTMAN
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 1:6209 SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8887
Mailing Address - Country:US
Mailing Address - Phone:843-360-1625
Mailing Address - Fax:
Practice Address - Street 1:2872 S HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7621
Practice Address - Country:US
Practice Address - Phone:843-357-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist