Provider Demographics
NPI:1962758177
Name:CHRISTNACHT, JENNIE LEE
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:LEE
Last Name:CHRISTNACHT
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 1:105 RAMPART DR
Mailing Address - Street 2:APT 206
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4365
Mailing Address - Country:US
Mailing Address - Phone:406-560-1509
Mailing Address - Fax:
Practice Address - Street 1:2611 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3759
Practice Address - Country:US
Practice Address - Phone:406-782-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist