Provider Demographics
NPI:1770868002
Name:DOTSON, JENNIE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:M
Last Name:DOTSON
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 1:3130 W CAREFREE HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3200
Mailing Address - Country:US
Mailing Address - Phone:623-582-8073
Mailing Address - Fax:623-582-8074
Practice Address - Street 1:3130 W CAREFREE HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3200
Practice Address - Country:US
Practice Address - Phone:623-582-8073
Practice Address - Fax:623-582-8074
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS014936OtherPHARMACIST LICENSE