Provider Demographics
NPI:1669451191
Name:HIRSH, JENNIFER MORGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MORGAN
Last Name:HIRSH
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 1:913 ELMWOOD AVE
Mailing Address - Street 2:APT A3
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:757-537-5005
Mailing Address - Fax:
Practice Address - Street 1:3001A 6TH ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207184183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist