Provider Demographics
NPI:1730346727
Name:LORD, JACQUELINE MARIE (PHARMACIST)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:LORD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4341
Mailing Address - Country:US
Mailing Address - Phone:310-472-0479
Mailing Address - Fax:
Practice Address - Street 1:1516 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4341
Practice Address - Country:US
Practice Address - Phone:310-472-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2015-05-01
Deactivation Date:2009-05-11
Deactivation Code:
Reactivation Date:2015-04-17
Provider Licenses
StateLicense IDTaxonomies
CA53671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist