Provider Demographics
NPI:1043330046
Name:JENNINGS, MARTHA BILLIE (BS PHARMACY)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:BILLIE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6138 BRISTOL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2905
Mailing Address - Country:US
Mailing Address - Phone:706-325-9229
Mailing Address - Fax:
Practice Address - Street 1:6770 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7201
Practice Address - Country:US
Practice Address - Phone:706-653-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist