Provider Demographics
NPI:1952610594
Name:MCKENNEY, JENNIFER RUTH (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454
Mailing Address - Country:US
Mailing Address - Phone:870-598-1700
Mailing Address - Fax:870-598-1702
Practice Address - Street 1:264 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2009
Practice Address - Country:US
Practice Address - Phone:870-324-5310
Practice Address - Fax:870-324-5311
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166339407Medicaid