Provider Demographics
NPI:1134564412
Name:ECCLES, JENNA MCGINN (RPH)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MCGINN
Last Name:ECCLES
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 1:6550 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3303
Mailing Address - Country:US
Mailing Address - Phone:303-530-0400
Mailing Address - Fax:
Practice Address - Street 1:6550 LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3303
Practice Address - Country:US
Practice Address - Phone:303-530-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14852OtherCOLORADO STATE BOARD OF PHARMACY