Provider Demographics
NPI:1861727281
Name:DION, JENNIFER LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DION
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 1:13720 HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7600
Mailing Address - Country:US
Mailing Address - Phone:704-821-1589
Mailing Address - Fax:704-821-1645
Practice Address - Street 1:13720 HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7600
Practice Address - Country:US
Practice Address - Phone:704-821-1589
Practice Address - Fax:704-821-1645
Is Sole Proprietor?:No
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0905496Medicaid
NC0282934156Medicare PIN