Provider Demographics
NPI:1104139203
Name:JENNE, JEFFREY ALAN (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:JENNE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1705
Mailing Address - Country:US
Mailing Address - Phone:856-429-0252
Mailing Address - Fax:856-429-3461
Practice Address - Street 1:715 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1705
Practice Address - Country:US
Practice Address - Phone:856-429-0252
Practice Address - Fax:856-429-3461
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02803600183500000X
PARP042564L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist