Provider Demographics
NPI:1699307595
Name:DAM, JILLIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DAM
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 1:2191 OCALA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1660
Mailing Address - Country:US
Mailing Address - Phone:408-440-7271
Mailing Address - Fax:
Practice Address - Street 1:1061 COCHRANE RD
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-9305
Practice Address - Country:US
Practice Address - Phone:408-310-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist