Provider Demographics
NPI:1558683839
Name:WEBER-ROE, JENNIFER (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEBER-ROE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7761
Mailing Address - Country:US
Mailing Address - Phone:859-918-1406
Mailing Address - Fax:
Practice Address - Street 1:8040 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1232
Practice Address - Country:US
Practice Address - Phone:859-283-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist