Provider Demographics
NPI:1780361477
Name:SMITH, JENNY GESSEL (CPHT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:GESSEL
Last Name:SMITH
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 1:1526 E ASPEN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1692
Mailing Address - Country:US
Mailing Address - Phone:801-234-0905
Mailing Address - Fax:
Practice Address - Street 1:1526 E ASPEN GROVE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1692
Practice Address - Country:US
Practice Address - Phone:801-234-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5271945-1717183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician