Provider Demographics
NPI:1063016509
Name:MCANNALLY, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MCANNALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-1428
Mailing Address - Country:US
Mailing Address - Phone:205-647-4441
Mailing Address - Fax:
Practice Address - Street 1:434 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-1428
Practice Address - Country:US
Practice Address - Phone:205-647-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist