Provider Demographics
NPI:1639702798
Name:DEADY, JENNIFER RENEE' (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENEE'
Last Name:DEADY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:RENEE '
Other - Last Name:FANELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2183 US HIGHWAY 82 114
Mailing Address - Street 2:
Mailing Address - City:CROSBYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79322-5213
Mailing Address - Country:US
Mailing Address - Phone:806-470-4777
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FLOYDADA
Practice Address - State:TX
Practice Address - Zip Code:79235-2726
Practice Address - Country:US
Practice Address - Phone:806-983-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist