Provider Demographics
NPI:1750469771
Name:NORRIS, JOLENE R (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:R
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MS
Other - First Name:JOLENE
Other - Middle Name:R
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:312 W WINTERS
Mailing Address - Street 2:
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-5252
Mailing Address - Country:US
Mailing Address - Phone:618-256-7335
Mailing Address - Fax:
Practice Address - Street 1:312 W WINTERS
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5252
Practice Address - Country:US
Practice Address - Phone:618-256-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist