Provider Demographics
NPI:1598999658
Name:MICHAILIDES, JENNIFER K (RPH, CGP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
Last Name:MICHAILIDES
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SQUIRRELS RUN
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-2503
Mailing Address - Country:US
Mailing Address - Phone:401-639-8471
Mailing Address - Fax:
Practice Address - Street 1:17 SQUIRRELS RUN
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-2503
Practice Address - Country:US
Practice Address - Phone:401-639-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI37361835G0303X
RI1790- CGP1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric