Provider Demographics
NPI:1336110014
Name:JENNINGS, WAYNE C (RPH)
Entity Type:Individual
Prefix:MS
First Name:WAYNE
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:C
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:800 LONGSTREET LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23437-9676
Mailing Address - Country:US
Mailing Address - Phone:757-657-9302
Mailing Address - Fax:
Practice Address - Street 1:100 FAIRVIEW DR.
Practice Address - Street 2:SOUTHAMPTON MEMORIAL HOSPITAL
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-569-6337
Practice Address - Fax:757-569-6341
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist