Provider Demographics
NPI:1700499217
Name:JARVIS, RENZEE JADE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENZEE
Middle Name:JADE
Last Name:JARVIS
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 1:111 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6428
Mailing Address - Country:US
Mailing Address - Phone:606-594-0603
Mailing Address - Fax:
Practice Address - Street 1:116 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-8590
Practice Address - Country:US
Practice Address - Phone:606-256-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist