Provider Demographics
NPI:1093346181
Name:BERHORST, JENNIFER RENAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAE
Last Name:BERHORST
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 1:606 HIGHWAY 63 S
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MO
Mailing Address - Zip Code:65582-8101
Mailing Address - Country:US
Mailing Address - Phone:573-422-6400
Mailing Address - Fax:
Practice Address - Street 1:606 HIGHWAY 63 S
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:MO
Practice Address - Zip Code:65582-8101
Practice Address - Country:US
Practice Address - Phone:573-422-6400
Practice Address - Fax:573-422-6403
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017032806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist