| NPI | 1437445616 |
|---|---|
| Former Name | CARRIE DONIELLE JACOBS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 59231) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 17487) |
| Enumeration Date | 2011-06-25 |
| Last Update Date | 2011-06-26 |