Provider Demographics
NPI:1992091649
Name:ILIFF, JACALYN R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACALYN
Middle Name:R
Last Name:ILIFF
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5450
Mailing Address - Country:US
Mailing Address - Phone:208-461-8718
Mailing Address - Fax:208-461-8720
Practice Address - Street 1:5875 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5450
Practice Address - Country:US
Practice Address - Phone:208-461-8718
Practice Address - Fax:208-461-8720
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7716183500000X
WY3456183500000X
IDP6841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist