Provider Demographics
NPI:1477820165
Name:LONSINGER, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LONSINGER
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 1:7295 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4556
Mailing Address - Country:US
Mailing Address - Phone:330-726-9374
Mailing Address - Fax:330-726-1677
Practice Address - Street 1:7295 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4556
Practice Address - Country:US
Practice Address - Phone:330-726-9374
Practice Address - Fax:330-726-1677
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129744183500000X
PARP446202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist