Provider Demographics
NPI:1669147823
Name:KONDOS, JENNFIER
Entity type:Individual
Prefix:
First Name:JENNFIER
Middle Name:
Last Name:KONDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 E GLENROSA AVE APT C1
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4034
Mailing Address - Country:US
Mailing Address - Phone:701-833-5385
Mailing Address - Fax:
Practice Address - Street 1:4500 E COTTON CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8840
Practice Address - Country:US
Practice Address - Phone:860-900-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist