Provider Demographics
NPI:1710386925
Name:STEVELEY, JENNA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:STEVELEY
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 1:17452 FREYMUTH RD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9014
Mailing Address - Country:US
Mailing Address - Phone:419-204-5464
Mailing Address - Fax:
Practice Address - Street 1:3710 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1619
Practice Address - Country:US
Practice Address - Phone:419-991-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist