Provider Demographics
NPI:1376143701
Name:SMITH, JENNIFER R (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SMITH
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 1:2925 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2684
Mailing Address - Country:US
Mailing Address - Phone:419-380-8670
Mailing Address - Fax:419-380-8713
Practice Address - Street 1:2925 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2684
Practice Address - Country:US
Practice Address - Phone:419-380-8670
Practice Address - Fax:419-380-8713
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist