Provider Demographics
NPI:1073117032
Name:TRENARY, JANE ANNE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANNE
Last Name:TRENARY
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 1:720 NORTHWESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:W LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-2652
Mailing Address - Country:US
Mailing Address - Phone:765-743-1554
Mailing Address - Fax:
Practice Address - Street 1:720 NORTHWESTERN AVE
Practice Address - Street 2:
Practice Address - City:W LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-2652
Practice Address - Country:US
Practice Address - Phone:765-743-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019718A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2601978AOtherRPH LICENSE