1164692208 NPI number — MS. JENNIFER SUSAN HARRISON PHARMACIST

Table of content: MS. JENNIFER SUSAN HARRISON PHARMACIST (NPI 1164692208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164692208 NPI number — MS. JENNIFER SUSAN HARRISON PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
JENNIFER
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164692208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 LOWDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREATOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61364-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-673-1993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH AND ROOSEVELT
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS CMOP , BUILDING 37
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141-5221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-786-7823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2008

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: 183500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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