Provider Demographics
NPI:1083909147
Name:BREESE, JENNIFER HIGGINS (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HIGGINS
Last Name:BREESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:401 S MOUNT JULIET RD STE 600
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8466
Mailing Address - Country:US
Mailing Address - Phone:615-773-2828
Mailing Address - Fax:615-773-2828
Practice Address - Street 1:401 S MOUNT JULIET RD STE 600
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8466
Practice Address - Country:US
Practice Address - Phone:615-773-2828
Practice Address - Fax:615-773-2828
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist