Provider Demographics
NPI:1811271752
Name:HART, JENNIFER ANN (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HART
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3856
Mailing Address - Country:US
Mailing Address - Phone:248-652-4429
Mailing Address - Fax:248-652-2735
Practice Address - Street 1:2050 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3856
Practice Address - Country:US
Practice Address - Phone:248-652-4429
Practice Address - Fax:248-652-2735
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist