Provider Demographics
NPI:1356564702
Name:REPINE, JANNA NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JANNA
Middle Name:NICOLE
Last Name:REPINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JANNA
Other - Middle Name:NICOLE
Other - Last Name:REPINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:21379 PINE CONE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4336
Mailing Address - Country:US
Mailing Address - Phone:765-714-9665
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1716
Practice Address - Country:US
Practice Address - Phone:586-466-9650
Practice Address - Fax:586-466-9960
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035452183500000X
IN45013462A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist