Provider Demographics
NPI:1821388802
Name:BACK, JANA RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:RENEE
Last Name:BACK
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 1:275 PRESTONSBURG ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-1135
Mailing Address - Country:US
Mailing Address - Phone:606-743-3425
Mailing Address - Fax:606-743-1936
Practice Address - Street 1:275 PRESTONSBURG ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1135
Practice Address - Country:US
Practice Address - Phone:606-743-3425
Practice Address - Fax:606-743-1936
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist