Provider Demographics
NPI:1063794907
Name:JENNINGS, CLEORA KATHERINE (PHARMD)
Entity type:Individual
Prefix:
First Name:CLEORA
Middle Name:KATHERINE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3000
Mailing Address - Country:US
Mailing Address - Phone:573-302-2700
Mailing Address - Fax:573-302-2701
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:417-532-4431
Practice Address - Fax:417-532-4431
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011027373OtherPHARMACIST LICENSE