Provider Demographics
NPI:1164692208
Name:HARRISON, JENNIFER SUSAN (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-1417
Mailing Address - Country:US
Mailing Address - Phone:815-673-1993
Mailing Address - Fax:
Practice Address - Street 1:5TH AND ROOSEVELT
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS CMOP , BUILDING 37
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5221
Practice Address - Country:US
Practice Address - Phone:708-786-7823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist