Provider Demographics
NPI:1376985770
Name:JEPPSON, JENAE ALIESE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:ALIESE
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-7501
Mailing Address - Country:US
Mailing Address - Phone:775-220-7005
Mailing Address - Fax:
Practice Address - Street 1:1465 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3278
Practice Address - Country:US
Practice Address - Phone:775-841-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist