Provider Demographics
NPI:1366873283
Name:VOGEL, JACQUELINE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:VOGEL
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 1:9012 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4502
Mailing Address - Country:US
Mailing Address - Phone:618-830-2201
Mailing Address - Fax:
Practice Address - Street 1:102 W VANDALIA ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1910
Practice Address - Country:US
Practice Address - Phone:618-692-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296185183500000X
MO2012031235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist