Provider Demographics
NPI:1265718233
Name:CHASE, JENNIFER LOUISE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-1596
Mailing Address - Country:US
Mailing Address - Phone:715-426-4089
Mailing Address - Fax:715-426-4095
Practice Address - Street 1:1047 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-1596
Practice Address - Country:US
Practice Address - Phone:715-426-4089
Practice Address - Fax:715-426-4095
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13153-40183500000X
MN116542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist