Healthcare Provider Details

I. General information

NPI: 1760204283
Provider Name (Legal Business Name): JENNIFER LEAH BRATTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W US HIGHWAY 36
PENDLETON IN
46064-9280
US

IV. Provider business mailing address

3676 E STATE ROAD 234
GREENFIELD IN
46140-7382
US

V. Phone/Fax

Practice location:
  • Phone: 765-703-3035
  • Fax: 765-221-7562
Mailing address:
  • Phone: 317-468-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26017999A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: