Provider Demographics
NPI:1528425535
Name:LANKFORD, JENNIFER M
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LANKFORD
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 1:304 E. JACKSON ST. #2D
Mailing Address - Street 2:P.O. BOX 244
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781
Mailing Address - Country:US
Mailing Address - Phone:417-742-3508
Mailing Address - Fax:417-685-3094
Practice Address - Street 1:304 E. JACKSON ST. #2D
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781
Practice Address - Country:US
Practice Address - Phone:417-742-3508
Practice Address - Fax:417-685-3094
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist