Provider Demographics
NPI:1578847265
Name:DAVIS, JENNIFER LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:DAVIS
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 1:139 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1640
Mailing Address - Country:US
Mailing Address - Phone:608-723-4737
Mailing Address - Fax:608-723-4735
Practice Address - Street 1:139 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1640
Practice Address - Country:US
Practice Address - Phone:608-723-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist