Individual
JACKLEEN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4310 WASHINGTON RD, EVANS, GA 30809-3957
(706) 860-4179
Mailing address
372 COLLINS GLEN CT, LAWRENCEVILLE, GA 30043-6848
(706) 773-9237
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH030830
GA
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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