Provider Demographics
NPI:1407882434
Name:POWERS, JENNIFER LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:POWERS
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 1:2854 OLIVINE DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7648
Mailing Address - Country:US
Mailing Address - Phone:770-339-7076
Mailing Address - Fax:770-339-7385
Practice Address - Street 1:631 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-339-2029
Practice Address - Fax:770-339-7385
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16820183500000X
GARPH023514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist