1295321495 NPI number — JENNIFER LONGMIRE DUNCAN PHARMD, BCGP

Table of content: JENNIFER LONGMIRE DUNCAN PHARMD, BCGP (NPI 1295321495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295321495 NPI number — JENNIFER LONGMIRE DUNCAN PHARMD, BCGP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN
Provider First Name:
JENNIFER
Provider Middle Name:
LONGMIRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCGP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LONGMIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295321495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 MERGANSER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39056-6259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-850-6353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BUSINESS PARK DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-214-9665
Provider Business Practice Location Address Fax Number:
800-547-9182
Provider Enumeration Date:
12/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835G0303X , with the licence number:  T-07963 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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