Provider Demographics
NPI:1669484739
Name:JENNINGS, LOMA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LOMA
Middle Name:MARIE
Last Name:JENNINGS
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 1:606 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0104
Mailing Address - Country:US
Mailing Address - Phone:605-721-0956
Mailing Address - Fax:
Practice Address - Street 1:1516 E SAINT PATRICK ST
Practice Address - Street 2:FAMILY THRIFT CENTER PHARMACY
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-4136
Practice Address - Country:US
Practice Address - Phone:605-343-6214
Practice Address - Fax:605-343-5212
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist