Provider Demographics
NPI:1356809859
Name:BACH, JACQUELINE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BACH
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 1:23 TRESTLES
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5611
Mailing Address - Country:US
Mailing Address - Phone:949-322-2385
Mailing Address - Fax:
Practice Address - Street 1:5481 COMMERCIAL DR STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1259
Practice Address - Country:US
Practice Address - Phone:855-699-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist