Provider Demographics
NPI:1902351331
Name:KNEEBUSCH, JAMIE CAROLINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:CAROLINE
Last Name:KNEEBUSCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:CAROLINE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25947 PROSPECTOR CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-2614
Mailing Address - Country:US
Mailing Address - Phone:951-805-8257
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist