Provider Demographics
NPI:1417389073
Name:DOCKERY, JENNIFER H (DPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 ROYAL HARBOUR CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9210
Mailing Address - Country:US
Mailing Address - Phone:423-238-6043
Mailing Address - Fax:
Practice Address - Street 1:7327 ROYAL HARBOUR CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9210
Practice Address - Country:US
Practice Address - Phone:423-238-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist