Healthcare Provider Details

I. General information

NPI: 1154023901
Provider Name (Legal Business Name): JENNIFER VANSICKLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 200
LANSING MI
48912-1806
US

IV. Provider business mailing address

1140 E MICHIGAN AVE STE 200
LANSING MI
48912-1806
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9403
  • Fax: 517-487-3148
Mailing address:
  • Phone: 517-364-9403
  • Fax: 517-487-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038809
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: