Provider Demographics
NPI:1598092108
Name:FOLLER, JENENAH A (RPH)
Entity Type:Individual
Prefix:
First Name:JENENAH
Middle Name:A
Last Name:FOLLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENENAH
Other - Middle Name:A
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:815 N PEPPERTREE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4920
Mailing Address - Country:US
Mailing Address - Phone:480-227-1880
Mailing Address - Fax:480-981-0156
Practice Address - Street 1:5941 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2754
Practice Address - Country:US
Practice Address - Phone:480-830-6343
Practice Address - Fax:480-981-0156
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS13522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS13522OtherSTATE LICENSE NUMBER