Provider Demographics
NPI:1700859774
Name:HUBBART, JENNY L (PHARMACY TECHNICAN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:HUBBART
Suffix:
Gender:F
Credentials:PHARMACY TECHNICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 N 225 W
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2772
Mailing Address - Country:US
Mailing Address - Phone:801-786-1799
Mailing Address - Fax:
Practice Address - Street 1:3795 KIESEL AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-1601
Practice Address - Country:US
Practice Address - Phone:801-394-6414
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336841-1717183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician