Provider Demographics
NPI:1467053728
Name:LOHR, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LOHR
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 1:6420 SUMMER PLACE DR E APT 1B
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8030
Mailing Address - Country:US
Mailing Address - Phone:419-410-6469
Mailing Address - Fax:
Practice Address - Street 1:30830 OLD US 20
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-9481
Practice Address - Country:US
Practice Address - Phone:574-674-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337960183500000X
IN26027794A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist