Provider Demographics
NPI:1043338825
Name:GENNRICH, JANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GENNRICH
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 1:5526 N SCHUBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4733
Mailing Address - Country:US
Mailing Address - Phone:208-888-6559
Mailing Address - Fax:
Practice Address - Street 1:2054 S SILVERSTONE WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8108
Practice Address - Country:US
Practice Address - Phone:208-887-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4997183500000X
CA41041183500000X
NV9530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist