Provider Demographics
NPI:1336477231
Name:SANDERSON, JENNIFER O'HEARN (PHARMD, BCPS, BCOP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:O'HEARN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCOP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ALISE
Other - Last Name:O'HEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD,BCPS,BCOP
Mailing Address - Street 1:4514 HIGH TOP CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-7020
Mailing Address - Country:US
Mailing Address - Phone:502-387-9443
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011831183500000X, 1835X0200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology