Provider Demographics
NPI:1023421153
Name:DENTEH, JENNIFER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DENTEH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 PALM TRACE LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1842
Mailing Address - Country:US
Mailing Address - Phone:954-513-0069
Mailing Address - Fax:
Practice Address - Street 1:1316 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5220
Practice Address - Country:US
Practice Address - Phone:410-749-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20586183500000X
DEA1-0004374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist