Provider Demographics
NPI:1710476197
Name:JENNINGS, MATTHEW JARROD (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JARROD
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1715
Mailing Address - Country:US
Mailing Address - Phone:845-300-6237
Mailing Address - Fax:
Practice Address - Street 1:1501 HELEN POWER DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3351
Practice Address - Country:US
Practice Address - Phone:707-451-1396
Practice Address - Fax:707-451-4857
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist