Provider Demographics
NPI:1770173742
Name:CUNLIFFE, JENNIFER (CPHT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CUNLIFFE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5839
Mailing Address - Country:US
Mailing Address - Phone:309-663-8344
Mailing Address - Fax:309-663-6182
Practice Address - Street 1:2611 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5839
Practice Address - Country:US
Practice Address - Phone:309-663-8344
Practice Address - Fax:309-663-6182
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.178024183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician