Provider Demographics
NPI:1841900271
Name:PATTON, JACKLYN LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:LOUISE
Last Name:PATTON
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 1:246 FRIENDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:246 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9704
Practice Address - Country:US
Practice Address - Phone:724-512-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459007183500000X
PA0890773146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate