Provider Demographics
NPI:1740958685
Name:STATEN, JENNIE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:ELIZABETH
Last Name:STATEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:535 JORDAN DR STE B
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5714
Mailing Address - Country:US
Mailing Address - Phone:870-224-0650
Mailing Address - Fax:870-224-0652
Practice Address - Street 1:535 JORDAN DR STE B
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5714
Practice Address - Country:US
Practice Address - Phone:870-224-0650
Practice Address - Fax:870-224-0652
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist