Provider Demographics
NPI:1750340659
Name:CHALFANT, JENNIFER REEVES (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REEVES
Last Name:CHALFANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 WINDING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8444
Mailing Address - Country:US
Mailing Address - Phone:937-492-8429
Mailing Address - Fax:
Practice Address - Street 1:112 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2731
Practice Address - Country:US
Practice Address - Phone:937-492-4550
Practice Address - Fax:937-497-7986
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-24598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist