Provider Demographics
NPI:1093310781
Name:BOVELL, JENNER CHANG (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNER
Middle Name:CHANG
Last Name:BOVELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JENNER
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:558 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2607
Mailing Address - Country:US
Mailing Address - Phone:256-479-2988
Mailing Address - Fax:
Practice Address - Street 1:796 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3067
Practice Address - Country:US
Practice Address - Phone:432-886-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist