Healthcare Provider Details

I. General information

NPI: 1073243259
Provider Name (Legal Business Name): JENNIFER FLYNN PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 W ANTHEM WAY
ANTHEM AZ
85086-0430
US

IV. Provider business mailing address

39911 N RIVER BEND RD
ANTHEM AZ
85086-4605
US

V. Phone/Fax

Practice location:
  • Phone: 623-745-3805
  • Fax:
Mailing address:
  • Phone: 602-319-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: