Provider Demographics
NPI:1770744179
Name:BALOUN, JENNIFER DENISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DENISE
Last Name:BALOUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9201
Mailing Address - Country:US
Mailing Address - Phone:615-672-4930
Mailing Address - Fax:615-672-6961
Practice Address - Street 1:480 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9201
Practice Address - Country:US
Practice Address - Phone:615-672-4930
Practice Address - Fax:615-672-6961
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26691183500000X
GARPH018246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist