Provider Demographics
NPI:1861767675
Name:OVERMAN, JEANNIE L (RPH)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:L
Last Name:OVERMAN
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 1:284 REGENT HILL CIR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2757
Mailing Address - Country:US
Mailing Address - Phone:801-255-5869
Mailing Address - Fax:
Practice Address - Street 1:11100 AUTO MALL DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4171
Practice Address - Country:US
Practice Address - Phone:801-790-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3171781701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist