Provider Demographics
NPI:1669870101
Name:CARNEY, JENNIFER (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CARNEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CARNEY-DIAMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 S ASPEN ST
Mailing Address - Street 2:STOP 89
Mailing Address - City:BUCKLEY AIR FORCE BASE
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9562
Mailing Address - Country:US
Mailing Address - Phone:720-847-6049
Mailing Address - Fax:720-847-7463
Practice Address - Street 1:317 N TELLURIDE ST
Practice Address - Street 2:BUILDING 7
Practice Address - City:BUCKLEY AIR FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80011-7809
Practice Address - Country:US
Practice Address - Phone:720-847-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist