Healthcare Provider Details

I. General information

NPI: 1508456534
Provider Name (Legal Business Name): JENNIFER LOWE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 E MOUNTAIN ST BLDG 319
KERNERSVILLE NC
27284-7998
US

IV. Provider business mailing address

549 ARBOR HILL RD APT 26C
KERNERSVILLE NC
27284-3313
US

V. Phone/Fax

Practice location:
  • Phone: 336-904-2704
  • Fax:
Mailing address:
  • Phone: 336-541-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number13445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: