Provider Demographics
NPI:1689899940
Name:SMITH, JENNIFER MAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAE
Last Name:SMITH
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 1:1843 JOHNSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-4799
Mailing Address - Country:US
Mailing Address - Phone:319-365-5343
Mailing Address - Fax:
Practice Address - Street 1:1843 JOHNSON AVE NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4752
Practice Address - Country:US
Practice Address - Phone:319-365-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist