Provider Demographics
NPI:1982048203
Name:BLACKMAN, JENNA KN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:KN
Last Name:BLACKMAN
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:UCSB STUDENT HEALTH BLDG 588
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-7002
Mailing Address - Country:US
Mailing Address - Phone:805-893-5361
Mailing Address - Fax:
Practice Address - Street 1:UCSB STUDENT HEALTH BLDG 588
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106
Practice Address - Country:US
Practice Address - Phone:805-893-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist