Provider Demographics
NPI:1639943814
Name:WITT, JENNIFER TILLEY (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:TILLEY
Last Name:WITT
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 1:7223 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4234
Mailing Address - Country:US
Mailing Address - Phone:540-561-3935
Mailing Address - Fax:540-561-3939
Practice Address - Street 1:7223 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4234
Practice Address - Country:US
Practice Address - Phone:540-561-3935
Practice Address - Fax:540-561-3939
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist