Provider Demographics
NPI:1043064181
Name:MCCOMBS, JENNIFER LYNEA (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNEA
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N FIR ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2713
Mailing Address - Country:US
Mailing Address - Phone:918-370-4433
Mailing Address - Fax:
Practice Address - Street 1:19801 ROBSON RD
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-1510
Practice Address - Country:US
Practice Address - Phone:918-739-7003
Practice Address - Fax:918-739-7004
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist