Provider Demographics
NPI:1194488627
Name:FORNOF, JENNIFER LYNN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:FORNOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 PA-88
Mailing Address - Street 2:
Mailing Address - City:FINLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15332
Mailing Address - Country:US
Mailing Address - Phone:724-348-6229
Mailing Address - Fax:
Practice Address - Street 1:3701 PA-88
Practice Address - Street 2:
Practice Address - City:FINLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15332
Practice Address - Country:US
Practice Address - Phone:724-348-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPO43966R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist