Provider Demographics
NPI:1336428846
Name:BURNEY, JENESSA DEFREES (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JENESSA
Middle Name:DEFREES
Last Name:BURNEY
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 1:2601 ELDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1090
Mailing Address - Country:US
Mailing Address - Phone:254-399-9585
Mailing Address - Fax:
Practice Address - Street 1:2601 ELDRIDGE LN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1090
Practice Address - Country:US
Practice Address - Phone:254-399-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist