Provider Demographics
NPI:1699818732
Name:GROVE, JENNIFER L (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GROVE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3131
Mailing Address - Country:US
Mailing Address - Phone:502-817-5761
Mailing Address - Fax:
Practice Address - Street 1:102 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095
Practice Address - Country:US
Practice Address - Phone:859-567-4601
Practice Address - Fax:859-567-4674
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12135183500000X
IN26022256A183500000X
TN0000028057183500000X
AR009343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist