1942202379 NPI number — DR. JENNIFER MARIE GEORGE PHARM.D,

Table of content: DR. JENNIFER MARIE GEORGE PHARM.D, (NPI 1942202379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942202379 NPI number — DR. JENNIFER MARIE GEORGE PHARM.D,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
JENNIFER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D,
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:
1942202379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 SOUTH PARK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-417-7115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6408 COPPS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-417-7115
Provider Business Practice Location Address Fax Number:
608-417-3001
Provider Enumeration Date:
08/15/2005

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:  14143-40 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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