Provider Demographics
NPI:1306446174
Name:CHADWICK TAVARES, JENNIFER FAITH (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAITH
Last Name:CHADWICK TAVARES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:FAITH
Other - Last Name:CHADWICK-TAVARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1309 SOLITAIRE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1109
Mailing Address - Country:US
Mailing Address - Phone:737-226-2879
Mailing Address - Fax:
Practice Address - Street 1:620 S INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4157
Practice Address - Country:US
Practice Address - Phone:512-869-4966
Practice Address - Fax:512-869-2188
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist