Provider Demographics
NPI:1841280609
Name:CHRISTMAN, JENNIFER L (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CHRISTMAN
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 1:12 PARK PL
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13452-1332
Mailing Address - Country:US
Mailing Address - Phone:518-568-2400
Mailing Address - Fax:518-568-2208
Practice Address - Street 1:12 PARK PL
Practice Address - Street 2:
Practice Address - City:ST JOHNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13452-1332
Practice Address - Country:US
Practice Address - Phone:518-568-2400
Practice Address - Fax:518-568-2208
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4774472-1701183500000X
NY048648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist