Provider Demographics
NPI:1548995228
Name:GALLIVAN, JENNIFER M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:GALLIVAN
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 1:3223 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3543
Mailing Address - Country:US
Mailing Address - Phone:513-633-6548
Mailing Address - Fax:
Practice Address - Street 1:9197 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3348
Practice Address - Country:US
Practice Address - Phone:513-733-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05440979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist