Provider Demographics
NPI:1508166679
Name:KOBYJANEC, JENNIFER N (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:N
Last Name:KOBYJANEC
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 1:7101 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4868
Mailing Address - Country:US
Mailing Address - Phone:505-821-1275
Mailing Address - Fax:505-821-6832
Practice Address - Street 1:7101 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4868
Practice Address - Country:US
Practice Address - Phone:505-821-1275
Practice Address - Fax:505-821-6832
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP0006539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP0006539OtherRPH LICENSE NUMBER