Provider Demographics
NPI:1902939846
Name:SERIG, JENNIFER LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:SERIG
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 1:420 MARKET ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1639
Mailing Address - Country:US
Mailing Address - Phone:423-570-0325
Mailing Address - Fax:423-775-1837
Practice Address - Street 1:420 MARKET ST UNIT 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1639
Practice Address - Country:US
Practice Address - Phone:423-570-0325
Practice Address - Fax:423-775-1837
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist