Provider Demographics
NPI:1063820488
Name:CLANCY, JENNIFER (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22981 HALL RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1539
Mailing Address - Country:US
Mailing Address - Phone:734-675-2211
Mailing Address - Fax:
Practice Address - Street 1:22981 HALL RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1539
Practice Address - Country:US
Practice Address - Phone:734-675-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist