Provider Demographics
NPI:1326299819
Name:PHILLIPS, JENNIFER DAVENPORT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DAVENPORT
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 FAIRLIE PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7842
Mailing Address - Country:US
Mailing Address - Phone:919-341-8950
Mailing Address - Fax:
Practice Address - Street 1:1515 W CORNWALLIS DR STE 208
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-6334
Practice Address - Country:US
Practice Address - Phone:919-819-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16346183500000X
VA0202205972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist