Provider Demographics
NPI:1588055982
Name:PLANK, JENNIFER D
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:PLANK
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 1:11 CROOKED DR
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1522
Mailing Address - Country:US
Mailing Address - Phone:717-512-2570
Mailing Address - Fax:
Practice Address - Street 1:11 CROOKED DR
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1522
Practice Address - Country:US
Practice Address - Phone:717-512-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist