Provider Demographics
NPI:1629737465
Name:TENGEN, JENNIFER S (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:TENGEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 YORKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1737
Mailing Address - Country:US
Mailing Address - Phone:443-839-4173
Mailing Address - Fax:
Practice Address - Street 1:735 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5812
Practice Address - Country:US
Practice Address - Phone:410-219-5261
Practice Address - Fax:410-219-5267
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist