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 |