Provider Demographics
NPI:1750675823
Name:PINEAULT, JENNIFER DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:PINEAULT
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 1:5230 CAMPBELL BLVD
Mailing Address - Street 2:T-1001
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4983
Mailing Address - Country:US
Mailing Address - Phone:410-818-8885
Mailing Address - Fax:
Practice Address - Street 1:5230 CAMPBELL BLVD
Practice Address - Street 2:T-1001
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4983
Practice Address - Country:US
Practice Address - Phone:410-818-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist