Provider Demographics
NPI:1699932780
Name:HERRELL, JENNIFER NICOLE (PHARMD,)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:HERRELL
Suffix:
Gender:F
Credentials:PHARMD,
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 BANK STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772
Mailing Address - Country:US
Mailing Address - Phone:256-437-2248
Mailing Address - Fax:256-437-9003
Practice Address - Street 1:85 BANK STREET
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772
Practice Address - Country:US
Practice Address - Phone:256-437-2248
Practice Address - Fax:256-437-9003
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000032304183500000X
AL15508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist