Provider Demographics
NPI:1427344399
Name:CORDER, JENNIFER ASHLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:CORDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9558
Mailing Address - Country:US
Mailing Address - Phone:336-454-3101
Mailing Address - Fax:336-454-8331
Practice Address - Street 1:407 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9558
Practice Address - Country:US
Practice Address - Phone:336-454-3101
Practice Address - Fax:336-454-8331
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist