Provider Demographics
NPI:1598106908
Name:DENNIS, JENNIFER LAUREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAUREY
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 COLUMBIA GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2539
Mailing Address - Country:US
Mailing Address - Phone:410-290-1054
Mailing Address - Fax:
Practice Address - Street 1:9616 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2104
Practice Address - Country:US
Practice Address - Phone:410-663-7957
Practice Address - Fax:410-663-6953
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist