Provider Demographics
NPI:1760767651
Name:MARTIN, JENIFER LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:LYNN
Last Name:MARTIN
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 1:1604 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1621
Mailing Address - Country:US
Mailing Address - Phone:303-388-7504
Mailing Address - Fax:303-388-7519
Practice Address - Street 1:1604 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1621
Practice Address - Country:US
Practice Address - Phone:303-388-7504
Practice Address - Fax:303-388-7519
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18232183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist