Provider Demographics
NPI:1952078305
Name:JACOWAY, KRISTINA NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NICOLE
Last Name:JACOWAY
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 1:2557 ROMAR DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2889
Mailing Address - Country:US
Mailing Address - Phone:724-734-6881
Mailing Address - Fax:
Practice Address - Street 1:31 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3903
Practice Address - Country:US
Practice Address - Phone:724-652-0981
Practice Address - Fax:724-658-7599
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI015223183500000X
PARP456036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist