Provider Demographics
NPI:1831254713
Name:JENNINGS, HEATH RANDEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:RANDEL
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC0010 TE026
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-5377
Mailing Address - Fax:773-702-6631
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC0010 TE026
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-5377
Practice Address - Fax:773-702-6631
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0115581835P1200X
IL0512924671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy