Provider Demographics
NPI:1912543703
Name:IVIE, JENNA E (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:E
Last Name:IVIE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ELIZABETH
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:225 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-1617
Mailing Address - Country:US
Mailing Address - Phone:573-359-1646
Mailing Address - Fax:573-359-2266
Practice Address - Street 1:225 S 3RD ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1617
Practice Address - Country:US
Practice Address - Phone:573-359-1646
Practice Address - Fax:573-359-2266
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019028671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist