Provider Demographics
NPI:1467865451
Name:RAEDER, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RAEDER
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 1:12601 W HAMPTON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1730
Mailing Address - Country:US
Mailing Address - Phone:262-781-0148
Mailing Address - Fax:
Practice Address - Street 1:12601 W HAMPTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1730
Practice Address - Country:US
Practice Address - Phone:262-781-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17212-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist