Provider Demographics
NPI:1356625024
Name:LINGENFELTER, JEANA RACHELE (PHARMD)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:RACHELE
Last Name:LINGENFELTER
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 1:3855 EVERGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0510
Mailing Address - Country:US
Mailing Address - Phone:559-970-5968
Mailing Address - Fax:
Practice Address - Street 1:1790 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4093
Practice Address - Country:US
Practice Address - Phone:559-299-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist