Provider Demographics
NPI:1770853194
Name:PAULUS, JENNIFER MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:PAULUS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 E SPRUCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2579
Mailing Address - Country:US
Mailing Address - Phone:715-861-4422
Mailing Address - Fax:715-861-5141
Practice Address - Street 1:13 E SPRUCE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2579
Practice Address - Country:US
Practice Address - Phone:715-861-4422
Practice Address - Fax:715-861-5141
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15572-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist