Provider Demographics
NPI:1780970608
Name:HABERKORN, JILL E (RPH)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:E
Last Name:HABERKORN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 SUNBURST DR
Mailing Address - Street 2:T0964
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8202
Mailing Address - Country:US
Mailing Address - Phone:919-778-1521
Mailing Address - Fax:919-778-1521
Practice Address - Street 1:1204 SUNBURST DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8202
Practice Address - Country:US
Practice Address - Phone:919-778-1521
Practice Address - Fax:919-778-1521
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist