Provider Demographics
NPI:1285222307
Name:WYNN, JENNIFER LANELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LANELLE
Last Name:WYNN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 RIDGEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-5004
Mailing Address - Country:US
Mailing Address - Phone:870-351-2942
Mailing Address - Fax:870-739-1702
Practice Address - Street 1:1303 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3633
Practice Address - Country:US
Practice Address - Phone:870-523-5888
Practice Address - Fax:870-523-9980
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist