Provider Demographics
NPI:1871072322
Name:VAN DE VENTER, JEANETTE BARBARA (BPHARM)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:BARBARA
Last Name:VAN DE VENTER
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16865 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3640
Mailing Address - Country:US
Mailing Address - Phone:317-773-1065
Mailing Address - Fax:317-773-4414
Practice Address - Street 1:16865 CLOVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3640
Practice Address - Country:US
Practice Address - Phone:317-773-1065
Practice Address - Fax:317-773-4414
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021088A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist