Healthcare Provider Details

I. General information

NPI: 1386160406
Provider Name (Legal Business Name): JENA PICKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41941 GARFIELD RD
CLINTON TOWNSHIP MI
48038-4541
US

IV. Provider business mailing address

42282 MANDALAY CT
STERLING HEIGHTS MI
48313-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302046933
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0021913
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: