Provider Demographics
NPI:1164649778
Name:SCAFFEDE, JENNY (RPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SCAFFEDE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CITADEL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1295
Mailing Address - Country:US
Mailing Address - Phone:630-222-4451
Mailing Address - Fax:
Practice Address - Street 1:3020 S WOLF ROAD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60514
Practice Address - Country:US
Practice Address - Phone:708-562-8101
Practice Address - Fax:706-562-4069
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist