Provider Demographics
NPI:1447355169
Name:ANDERSON, JENNIFER BLAIR (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BLAIR
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1620
Mailing Address - Country:US
Mailing Address - Phone:606-784-4784
Mailing Address - Fax:606-784-5858
Practice Address - Street 1:208 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1620
Practice Address - Country:US
Practice Address - Phone:606-784-4784
Practice Address - Fax:606-784-5858
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist