Provider Demographics
NPI:1730410259
Name:POWELL, JENNIFER RENEE (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:POWELL
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 1:8310 W DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-362-1960
Mailing Address - Fax:623-362-2029
Practice Address - Street 1:8310 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2461
Practice Address - Country:US
Practice Address - Phone:623-362-1960
Practice Address - Fax:623-362-2029
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017042183500000X
IA20419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist