1598887622 NPI number — MRS. JENNIFER LEIGH LOVENDUSKI RPH

Table of content: MRS. JENNIFER LEIGH LOVENDUSKI RPH (NPI 1598887622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598887622 NPI number — MRS. JENNIFER LEIGH LOVENDUSKI RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVENDUSKI
Provider First Name:
JENNIFER
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1598887622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3413 NYS ROUTE 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13367-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KINNEY DRUGS
Provider Second Line Business Practice Location Address:
7395 UTICA BOULEVARD
Provider Business Practice Location Address City Name:
LOWVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-376-7551
Provider Business Practice Location Address Fax Number:
315-376-4353
Provider Enumeration Date:
04/06/2007

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 , with the licence number:  047819-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 047819-1 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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