Provider Demographics
NPI:1851672315
Name:BEJAOUI, JENNIFER A (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:BEJAOUI
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 1:319 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3117
Mailing Address - Country:US
Mailing Address - Phone:630-971-0450
Mailing Address - Fax:
Practice Address - Street 1:540 N SCHMALE RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1867
Practice Address - Country:US
Practice Address - Phone:630-933-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist