Individual
JACLYNN R LAVIOLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2107 S 11TH ST, NILES, MI 49120-4060
(269) 683-5573
Mailing address
19241 COPPER BROOK DR, SOUTH BEND, IN 46637-2417
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302029320
MI
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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