Provider Demographics
NPI:1083056998
Name:FORD, JENNIFER MARY (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARY
Last Name:FORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARY
Other - Last Name:PIECHOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8940 TOWN AND COUNTRY BLVD
Mailing Address - Street 2:APT F
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3125
Mailing Address - Country:US
Mailing Address - Phone:443-904-5378
Mailing Address - Fax:
Practice Address - Street 1:13600 BALTIMORE AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-575-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist