Provider Demographics
NPI:1639452097
Name:TIMPE, JENNIFER MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:TIMPE
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 1:34093 CATFISH CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62012-4040
Mailing Address - Country:US
Mailing Address - Phone:618-401-6635
Mailing Address - Fax:
Practice Address - Street 1:705 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2340
Practice Address - Country:US
Practice Address - Phone:618-498-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist