Provider Demographics
NPI:1790302974
Name:MAHESH, JENNECA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNECA
Middle Name:
Last Name:MAHESH
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 1:1806 MOUNTAINBROOK DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1356
Mailing Address - Country:US
Mailing Address - Phone:256-783-0125
Mailing Address - Fax:
Practice Address - Street 1:310 PELHAM AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5016
Practice Address - Country:US
Practice Address - Phone:256-534-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist