Healthcare Provider Details

I. General information

NPI: 1427694801
Provider Name (Legal Business Name): JENNIFER ZAETSCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 CHILSON CMNS
PINCKNEY MI
48169-9594
US

IV. Provider business mailing address

6566 SOFTSHELL DR
GRASS LAKE MI
49240-7039
US

V. Phone/Fax

Practice location:
  • Phone: 734-213-7980
  • Fax:
Mailing address:
  • Phone: 734-476-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1811921687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: