Provider Demographics
NPI:1215215694
Name:NASH, JENNY T (RPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:T
Last Name:NASH
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 1:1001 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4640
Mailing Address - Country:US
Mailing Address - Phone:337-433-1429
Mailing Address - Fax:337-433-9971
Practice Address - Street 1:1001 3RD AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4640
Practice Address - Country:US
Practice Address - Phone:337-433-1429
Practice Address - Fax:337-433-9971
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist