Provider Demographics
NPI:1508313644
Name:JENNERS, SYDNEY RE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RE
Last Name:JENNERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:RE
Other - Last Name:VEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13880 TOWNE PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-3345
Mailing Address - Country:US
Mailing Address - Phone:407-857-4548
Mailing Address - Fax:
Practice Address - Street 1:13880 TOWNE PLACE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3345
Practice Address - Country:US
Practice Address - Phone:407-857-4548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist