Provider Demographics
NPI:1053564914
Name:KATICH, JACQUELINE JOYCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JOYCE
Last Name:KATICH
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 1:1441 FOX RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5900
Mailing Address - Country:US
Mailing Address - Phone:334-741-4150
Mailing Address - Fax:334-741-4122
Practice Address - Street 1:1441 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5900
Practice Address - Country:US
Practice Address - Phone:334-741-4150
Practice Address - Fax:334-741-4122
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist