Provider Demographics
NPI:1720324395
Name:DAILEY, JENNA LAINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LAINE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3388 RECREATION DR
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-3407
Mailing Address - Country:US
Mailing Address - Phone:478-982-1173
Mailing Address - Fax:
Practice Address - Street 1:400 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1501
Practice Address - Country:US
Practice Address - Phone:706-437-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist