Provider Demographics
NPI:1588947642
Name:FELDHAUS, JENNIFER GORDON (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GORDON
Last Name:FELDHAUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2845
Mailing Address - Country:US
Mailing Address - Phone:931-680-4725
Mailing Address - Fax:931-680-7285
Practice Address - Street 1:826 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2845
Practice Address - Country:US
Practice Address - Phone:931-680-4725
Practice Address - Fax:931-680-7285
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist