Provider Demographics
NPI:1740437854
Name:JENNINGS, JOHN MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6925 STATE ROAD C
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-6338
Mailing Address - Country:US
Mailing Address - Phone:573-642-7296
Mailing Address - Fax:573-642-9447
Practice Address - Street 1:600 COURT ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-642-6892
Practice Address - Fax:573-642-9447
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist