Provider Demographics
NPI:1548530470
Name:POWE, JENNIFER K (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:POWE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3212
Mailing Address - Country:US
Mailing Address - Phone:708-755-4437
Mailing Address - Fax:
Practice Address - Street 1:18133 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2157
Practice Address - Country:US
Practice Address - Phone:708-889-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist