Provider Demographics
NPI:1417557208
Name:PARKER, JENNIFER ELEXUS (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELEXUS
Last Name:PARKER
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 1:689 E 600 S
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9219
Mailing Address - Country:US
Mailing Address - Phone:317-224-4066
Mailing Address - Fax:
Practice Address - Street 1:2025 MERCHANT MILE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1572
Practice Address - Country:US
Practice Address - Phone:812-376-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019618A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist