Healthcare Provider Details

I. General information

NPI: 1699689802
Provider Name (Legal Business Name): JENNIFER LYNN CHURCH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 HARRODS VIEW CIR
PROSPECT KY
40059-9475
US

IV. Provider business mailing address

6715 HARRODS VIEW CIR
PROSPECT KY
40059-9475
US

V. Phone/Fax

Practice location:
  • Phone: 502-802-0461
  • Fax:
Mailing address:
  • Phone: 502-802-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: