Provider Demographics
NPI:1154683670
Name:FREY, JENNIFER JOAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:FREY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1755
Mailing Address - Country:US
Mailing Address - Phone:765-457-1440
Mailing Address - Fax:765-457-6979
Practice Address - Street 1:705 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1755
Practice Address - Country:US
Practice Address - Phone:765-457-1440
Practice Address - Fax:765-457-6979
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023840A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist