Provider Demographics
NPI:1912497793
Name:ZEIS, JEANNE ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:ANN
Last Name:ZEIS
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 1:434 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2342
Mailing Address - Country:US
Mailing Address - Phone:859-431-3304
Mailing Address - Fax:859-431-3305
Practice Address - Street 1:434 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2342
Practice Address - Country:US
Practice Address - Phone:859-431-3304
Practice Address - Fax:859-431-3305
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP010459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54032347Medicaid
KY7100068600Medicaid
KY54018452Medicaid