Provider Demographics
NPI:1104420967
Name:SANTEL, JENNA MICHELLE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:SANTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6266
Mailing Address - Country:US
Mailing Address - Phone:618-244-9660
Mailing Address - Fax:618-244-9551
Practice Address - Street 1:415 S 42ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6266
Practice Address - Country:US
Practice Address - Phone:618-244-9660
Practice Address - Fax:618-244-9551
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512983341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist