Provider Demographics
NPI:1700543600
Name:SCHMUCKER, JENNY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:SCHMUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SULLIVAN PL
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9610
Mailing Address - Country:US
Mailing Address - Phone:845-238-9285
Mailing Address - Fax:
Practice Address - Street 1:110 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-1956
Practice Address - Country:US
Practice Address - Phone:912-748-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA020554OtherPHARMACIST