Provider Demographics
NPI:1962725606
Name:JACKOVIC, THERESA M (PHARM D)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:JACKOVIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 OLD BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-1112
Mailing Address - Country:US
Mailing Address - Phone:412-526-1753
Mailing Address - Fax:
Practice Address - Street 1:720 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-4517
Practice Address - Country:US
Practice Address - Phone:412-653-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist