Provider Demographics
NPI:1609480912
Name:CRAPUCHETTES, JENNALYN JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNALYN
Middle Name:JOY
Last Name:CRAPUCHETTES
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 1:622 E USTICK RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6311
Mailing Address - Country:US
Mailing Address - Phone:208-454-5640
Mailing Address - Fax:
Practice Address - Street 1:622 E USTICK RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6311
Practice Address - Country:US
Practice Address - Phone:208-454-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist