Provider Demographics
NPI:1316218738
Name:PERRY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PERRY
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 1:2697 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7148
Mailing Address - Country:US
Mailing Address - Phone:720-214-5532
Mailing Address - Fax:720-214-5538
Practice Address - Street 1:2697 W BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7148
Practice Address - Country:US
Practice Address - Phone:720-214-5532
Practice Address - Fax:720-214-5538
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20229183500000X
PARP445671183500000X
COPHA.0021275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist