Provider Demographics
NPI:1518010396
Name:STARK, JENNIFER E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:STARK
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 1:5826 DANCING RABBIT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6277
Mailing Address - Country:US
Mailing Address - Phone:479-304-8889
Mailing Address - Fax:
Practice Address - Street 1:5826 DANCING RABBIT DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6277
Practice Address - Country:US
Practice Address - Phone:479-304-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK128731835P1200X
ARPD109611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy