Provider Demographics
NPI:1952728453
Name:LEGG, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 E VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4132
Mailing Address - Country:US
Mailing Address - Phone:414-736-0277
Mailing Address - Fax:
Practice Address - Street 1:2654 ELM DR
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8936
Practice Address - Country:US
Practice Address - Phone:414-736-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60235935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist