Provider Demographics
NPI:1063054740
Name:BACH, JENNIFER ANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:BACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:BURCKARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7505 ASHERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8474
Mailing Address - Country:US
Mailing Address - Phone:502-931-8562
Mailing Address - Fax:
Practice Address - Street 1:13410 EASTPOINT CENTRE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4160
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist