Provider Demographics
NPI:1467513416
Name:STICKNEY, JENNIFER RENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENE
Last Name:STICKNEY
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 1:213 W INSTITUTE PL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3121
Mailing Address - Country:US
Mailing Address - Phone:312-337-7750
Mailing Address - Fax:312-337-7760
Practice Address - Street 1:213 W INSTITUTE PL
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3121
Practice Address - Country:US
Practice Address - Phone:312-337-7750
Practice Address - Fax:312-337-7760
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist