Provider Demographics
NPI:1720689367
Name:SMITH, JENNIFER CLAUDIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLAUDIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 EVANS TO LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5073
Mailing Address - Country:US
Mailing Address - Phone:706-941-5857
Mailing Address - Fax:
Practice Address - Street 1:3851 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5073
Practice Address - Country:US
Practice Address - Phone:706-941-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist