Provider Demographics
NPI:1669018883
Name:SHUKLA, JENNA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MICHELLE
Other - Last Name:HEBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8447 CLEARWATER LN APT 106
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1673
Mailing Address - Country:US
Mailing Address - Phone:317-512-8854
Mailing Address - Fax:
Practice Address - Street 1:5911 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-4726
Practice Address - Country:US
Practice Address - Phone:317-791-3545
Practice Address - Fax:317-791-3547
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018726183500000X, 1835P0018X
IN26026631A183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist