Provider Demographics
NPI:1134442379
Name:KERLEY, JENNIFER JOYCE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOYCE
Last Name:KERLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:THREE MILE BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13693-0294
Mailing Address - Country:US
Mailing Address - Phone:315-649-2269
Mailing Address - Fax:
Practice Address - Street 1:25737 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637
Practice Address - Country:US
Practice Address - Phone:315-629-2402
Practice Address - Fax:315-629-4305
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist