Provider Demographics
NPI:1801403852
Name:WARNER, JEANANNA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEANANNA
Middle Name:MARIE
Last Name:WARNER
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 1:1285 OLD TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-3937
Mailing Address - Country:US
Mailing Address - Phone:518-848-6445
Mailing Address - Fax:
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2623
Practice Address - Country:US
Practice Address - Phone:518-762-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist