Provider Demographics
NPI:1841372893
Name:TRUDO, JENNY LYNN
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:TRUDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:SD
Mailing Address - Zip Code:57455-0097
Mailing Address - Country:US
Mailing Address - Phone:605-768-2115
Mailing Address - Fax:
Practice Address - Street 1:103 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1101
Practice Address - Country:US
Practice Address - Phone:605-765-9458
Practice Address - Fax:605-765-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT0280183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician