Provider Demographics
NPI:1750664751
Name:PRATER, JENNIFER L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PRATER
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 1:3497 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2599
Mailing Address - Country:US
Mailing Address - Phone:636-625-0691
Mailing Address - Fax:636-625-0694
Practice Address - Street 1:530 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2150
Practice Address - Country:US
Practice Address - Phone:636-970-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist