Healthcare Provider Details

I. General information

NPI: 1659867364
Provider Name (Legal Business Name): JENNIFER OVERMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 08/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 NM HWY 528 NE
RIO RANCHO NM
87144-7650
US

IV. Provider business mailing address

3777 NM HWY 528 NE
RIO RANCHO NM
87144-7650
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-2590
  • Fax:
Mailing address:
  • Phone: 505-404-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000293
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP00008547
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: