Provider Demographics
NPI:1831792662
Name:YAKOPOVIC, JENNIFER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:YAKOPOVIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 RUSTY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1973
Mailing Address - Country:US
Mailing Address - Phone:314-892-6428
Mailing Address - Fax:
Practice Address - Street 1:4250 RUSTY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1973
Practice Address - Country:US
Practice Address - Phone:314-892-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000000OtherRETAIL PHARMACIST