1699932780 NPI number — MRS. JENNIFER NICOLE HERRELL PHARMD,

Table of content: MRS. JENNIFER NICOLE HERRELL PHARMD, (NPI 1699932780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699932780 NPI number — MRS. JENNIFER NICOLE HERRELL PHARMD,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRELL
Provider First Name:
JENNIFER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699932780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 BANK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-437-2248
Provider Business Mailing Address Fax Number:
256-437-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 BANK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-437-2248
Provider Business Practice Location Address Fax Number:
256-437-9003
Provider Enumeration Date:
05/17/2008

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 , with the licence number:  0000032304 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 15508 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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