Provider Demographics
NPI:1780935304
Name:BARRACLOUGH, JACQUELINE KELLY
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KELLY
Last Name:BARRACLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ARCADIA AVE APT 914
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3027
Mailing Address - Country:US
Mailing Address - Phone:520-290-5891
Mailing Address - Fax:
Practice Address - Street 1:250 N ARCADIA AVE APT 914
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3027
Practice Address - Country:US
Practice Address - Phone:520-290-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI00093131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist