Provider Demographics
NPI:1235648106
Name:JENNINGS, IJEOMA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:ANN
Last Name:JENNINGS
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 1:365 MATHER ST APT 106
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3130
Mailing Address - Country:US
Mailing Address - Phone:203-737-0713
Mailing Address - Fax:
Practice Address - Street 1:414 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4846
Practice Address - Country:US
Practice Address - Phone:203-336-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist