Provider Demographics
NPI:1841454915
Name:CHURCH, JENNIFER HONEYCUTT
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HONEYCUTT
Last Name:CHURCH
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 1:10930 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6593
Mailing Address - Country:US
Mailing Address - Phone:919-844-2055
Mailing Address - Fax:919-844-2054
Practice Address - Street 1:10930 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6593
Practice Address - Country:US
Practice Address - Phone:919-844-2055
Practice Address - Fax:919-844-2054
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19749OtherNC PHARMACIST LICENSE