Provider Demographics
NPI:1205119997
Name:COLLETT, JENNIFER (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COLLETT
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 1:1601 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2634
Mailing Address - Country:US
Mailing Address - Phone:859-291-7343
Mailing Address - Fax:859-291-8169
Practice Address - Street 1:1601 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2634
Practice Address - Country:US
Practice Address - Phone:859-291-7343
Practice Address - Fax:859-291-8169
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist