Provider Demographics
NPI:1588752463
Name:DAGGETT, JENNIFER JOYCE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOYCE
Last Name:DAGGETT
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 1:12934 PRAIRIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8104
Mailing Address - Country:US
Mailing Address - Phone:605-225-3964
Mailing Address - Fax:605-725-2349
Practice Address - Street 1:815 1ST AVE SE
Practice Address - Street 2:#202
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4602
Practice Address - Country:US
Practice Address - Phone:605-725-4001
Practice Address - Fax:605-725-2349
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5148OtherSTATE LICENSE NUMBER