Provider Demographics
NPI:1558443507
Name:BEETSCH, JENNY RENEE
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:RENEE
Last Name:BEETSCH
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 1:701 E LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1617
Mailing Address - Country:US
Mailing Address - Phone:605-765-9499
Mailing Address - Fax:
Practice Address - Street 1:103 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1101
Practice Address - Country:US
Practice Address - Phone:605-765-9458
Practice Address - Fax:605-765-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT1084183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician