Provider Demographics
NPI:1518324078
Name:JENNYS YOUR FRIENDLY PHARMACY
Entity Type:Organization
Organization Name:JENNYS YOUR FRIENDLY PHARMACY
Other - Org Name:JENNYS YOUR FRIENDLY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,AO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:786-252-8423
Mailing Address - Street 1:2217 NW 7TH ST # CU-2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3330
Mailing Address - Country:US
Mailing Address - Phone:786-533-8269
Mailing Address - Fax:844-287-8887
Practice Address - Street 1:2217 NW 7TH ST # CU-2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3330
Practice Address - Country:US
Practice Address - Phone:786-533-8269
Practice Address - Fax:844-287-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH297923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157757OtherPK
FL017271400Medicaid