Provider Demographics
NPI:1245069053
Name:BOSTICK, JENNIFER G (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:BOSTICK
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 1:2507 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5125
Mailing Address - Country:US
Mailing Address - Phone:318-396-4466
Mailing Address - Fax:
Practice Address - Street 1:181 HOPEWELL HILL DR
Practice Address - Street 2:
Practice Address - City:CHOUDRANT
Practice Address - State:LA
Practice Address - Zip Code:71227-5900
Practice Address - Country:US
Practice Address - Phone:318-376-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist