Provider Demographics
NPI:1740586759
Name:SMITH, JENNIFER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BECHELLI LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3556
Mailing Address - Country:US
Mailing Address - Phone:530-222-8097
Mailing Address - Fax:530-222-8081
Practice Address - Street 1:4805 BECHELLI LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3556
Practice Address - Country:US
Practice Address - Phone:530-222-8097
Practice Address - Fax:530-222-8081
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist