Provider Demographics
NPI:1942595756
Name:EBERLE, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:EBERLE
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 1:6189 STATE ROUTE 31
Mailing Address - Street 2:WALGREENS # 10750
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9218
Mailing Address - Country:US
Mailing Address - Phone:315-699-0812
Mailing Address - Fax:
Practice Address - Street 1:6189 STATE ROUTE 31
Practice Address - Street 2:WALGREENS # 10750
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9218
Practice Address - Country:US
Practice Address - Phone:315-699-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist