Provider Demographics
NPI:1770647265
Name:RIBAUDO, JENNIFER A
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:RIBAUDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:VOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-661-1408
Mailing Address - Fax:716-661-1074
Practice Address - Street 1:712 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2914
Practice Address - Country:US
Practice Address - Phone:716-661-1520
Practice Address - Fax:716-661-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist