Provider Demographics
NPI:1407406929
Name:HERR, JENNA LYNN
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:HERR
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 1:7434 ROUTE 98
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-9713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1060
Practice Address - Country:US
Practice Address - Phone:607-776-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist