Provider Demographics
NPI:1205187382
Name:PARKER, JENNIFER LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:PARKER
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 1:212 WEST ST
Mailing Address - Street 2:
Mailing Address - City:DANE
Mailing Address - State:WI
Mailing Address - Zip Code:53529-9717
Mailing Address - Country:US
Mailing Address - Phone:608-712-8513
Mailing Address - Fax:
Practice Address - Street 1:233 S CENTURY AVE
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1249
Practice Address - Country:US
Practice Address - Phone:608-849-7888
Practice Address - Fax:608-849-7474
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14723-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist