Provider Demographics
NPI:1700314093
Name:MOORE, JENNIFER ASHLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:MOORE
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 1:320 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-8231
Mailing Address - Country:US
Mailing Address - Phone:205-242-9598
Mailing Address - Fax:205-242-9598
Practice Address - Street 1:5100 HIGHWAY 39 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1023
Practice Address - Country:US
Practice Address - Phone:601-485-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist