Provider Demographics
NPI:1598380461
Name:MANATREY-LANCASTER, JENNA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:JEAN
Last Name:MANATREY-LANCASTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:JEAN
Other - Last Name:MANATREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1687
Mailing Address - Country:US
Mailing Address - Phone:515-720-4592
Mailing Address - Fax:
Practice Address - Street 1:1002 SE NATIONAL DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-3996
Practice Address - Country:US
Practice Address - Phone:515-963-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist