Provider Demographics
NPI:1629099098
Name:BEHRENS, JANA M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:M
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29863 SW 158TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033
Mailing Address - Country:US
Mailing Address - Phone:305-245-3289
Mailing Address - Fax:
Practice Address - Street 1:3100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1162
Practice Address - Country:US
Practice Address - Phone:575-525-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40166183500000X
NMRP00007077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist