Provider Demographics
NPI:1811760226
Name:KEMNA, JENNIFER NICOLE (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:KEMNA
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 1:2850 E FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-8918
Mailing Address - Country:US
Mailing Address - Phone:573-881-0336
Mailing Address - Fax:
Practice Address - Street 1:101 S FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7637
Practice Address - Country:US
Practice Address - Phone:573-884-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist