Provider Demographics
NPI:1679868624
Name:RHODES, JENNIFER KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:RHODES
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 1:197 GRAVOIS BLUFFS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4013
Mailing Address - Country:US
Mailing Address - Phone:636-326-7508
Mailing Address - Fax:
Practice Address - Street 1:197 GRAVOIS BLUFFS PLAZA DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4013
Practice Address - Country:US
Practice Address - Phone:636-326-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011011803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist