Provider Demographics
NPI:1952656068
Name:STANG, JENNA LYNN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:LYNN
Last Name:STANG
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 1:4313 MCGEE ST
Mailing Address - Street 2:APT 1N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1725
Mailing Address - Country:US
Mailing Address - Phone:402-212-3422
Mailing Address - Fax:
Practice Address - Street 1:4313 MCGEE ST
Practice Address - Street 2:APT 1N
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1725
Practice Address - Country:US
Practice Address - Phone:402-212-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist