Provider Demographics
NPI:1720108392
Name:VARGAS, JENNIFER E (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:VARGAS
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 1:9013 REDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-3788
Mailing Address - Country:US
Mailing Address - Phone:708-479-1464
Mailing Address - Fax:
Practice Address - Street 1:4233 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2403
Practice Address - Country:US
Practice Address - Phone:708-747-9191
Practice Address - Fax:708-747-8399
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist