Provider Demographics
NPI:1699112581
Name:SANTIBANEZ, JENNIFER HORTON (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HORTON
Last Name:SANTIBANEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16552 MILWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7334
Mailing Address - Country:US
Mailing Address - Phone:864-706-1532
Mailing Address - Fax:
Practice Address - Street 1:1710 W GENTRY PKWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-3926
Practice Address - Country:US
Practice Address - Phone:903-595-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50528183500000X
SC13419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist