Provider Demographics
NPI:1881759553
Name:DICENZO, JENNIFER JOY (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:DICENZO
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 1:7899 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2817
Mailing Address - Country:US
Mailing Address - Phone:812-853-8474
Mailing Address - Fax:
Practice Address - Street 1:6700 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4034
Practice Address - Country:US
Practice Address - Phone:812-473-5892
Practice Address - Fax:812-473-6432
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020681A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist