Provider Demographics
NPI:1720297153
Name:TAKOUSHIAN, JAMIE ELIZABETH (RPH)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:TAKOUSHIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7175
Mailing Address - Country:US
Mailing Address - Phone:610-517-8121
Mailing Address - Fax:
Practice Address - Street 1:1140 MCDERMOTT DR STE 104
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4043
Practice Address - Country:US
Practice Address - Phone:610-696-3100
Practice Address - Fax:610-696-7100
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035779T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01947300OtherPHARMACIST LICENSE NEW JERSEY
PARP035779TOtherPA. PHARMACIST LICENSE