Healthcare Provider Details

I. General information

NPI: 1679497549
Provider Name (Legal Business Name): JASON JENNINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W GROVE ST
EL DORADO AR
71730-4415
US

IV. Provider business mailing address

635 CHAMPAGNOLLE RD APT A
EL DORADO AR
71730-4758
US

V. Phone/Fax

Practice location:
  • Phone: 870-881-8434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17851
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: